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Assessment of Tumor Vascularity in Lung Cancer Using Volume Perfusion CT (VPCT) With Histopathologic Comparison: A Further Step Toward an Individualized Tumor Characterization

Spira, Daniel MD; Neumeister, Helge MD; Spira, Sven Michael MSc; Hetzel, Jürgen MD; Spengler, Werner MD; von Weyhern, Claus Hann MD; Horger, Marius MD

Journal of Computer Assisted Tomography: January/February 2013 - Volume 37 - Issue 1 - p 15–21
doi: 10.1097/RCT.0b013e318277c84f
Thoracic Imaging

Objective To measure perfusion in different lung cancer subtypes and compare results with histopathological/immunohistochemical results.

Methods Seventy-two consecutive untreated patients with lung cancer (40 adenocarcinomas, 20 squamous cell, and 12 small cell lung cancers) were enrolled. A 40-second volume perfusion computed tomography of the tumor bulk was obtained. Blood flow (BF), blood volume (BV), and transit constant were determined. Tumor volume and tumor necrosis were determined on contrast-enhanced computed tomography. Pathologic specimens were assessed for microvessel density (MVD), hypoxia-induced transcription (hif-1/-2), and proliferation (Ki-67).

Results Higher MVD is associated with higher BF and BV. Higher tumor grade leads to lower BF but increased necrosis and tumor volume. Markers of hypoxia were independent from perfusion parameters, extent of necrosis or MVD. Blood flow, BV, and MVD were not significantly different among lung cancer subtypes. Transit constant was significantly reduced in small cell lung cancer versus adenocarcinoma.

Conclusions Perfusion values are related to MVD and tumor grade but vary considerably among lung cancer subtypes.

From the *Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tübingen, Germany; †Finance Department, HEC Paris, Jouy en Josas, France; ‡Department of Oncology, Hematology, Immunology, Rheumatology and Pulmonology, Eberhard-Karls University, Tübingen, Germany; and §Institute of Pathology, Eberhard-Karls-University, Tübingen, Germany.

Received for publication September 6, 2012; accepted October 5, 2012.

Reprints: Daniel Spira, MD, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany (e-mail:

The authors declare no conflicts of interest or financial disclosures.

Claus Hann von Weyhern and Marius Horger share senior authorship.

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