467 lesions prospectively studied from January to Dec 2008.
36 brain lesions
98 head and neck pathologies
11 spinal pathologies
11 breast malignancies
26 esophageal pathologies
142 lung pathologies
101 abdominal pathologies
42 pelvic pathologies
CT perfusion was performed with a 64 –slice MDCT.
Tumor was localized and a 4-cm lesions region was selected independently for the dynamic study .
Contrast bolus infusion at a rate of 50 mL at 5 mL/sec for 10 seconds, followed by a saline flush at 40 mL at 5mL/sec for 8 seconds.
Total 30 dynamic acquisitions with inter - cycle interval 2sec and total scan time 60 seconds.
Followed by routine contrast-enhanced scan. This scan was used for routine cancer diagnosis.
We used maximum slope analytical model method, yielding five major kinetic parameters:
(1) Perfusion (measured in ml/min/ml);
(2) Peak enhancement intensity (PEI, measured in HU);
(3) Time to peak (TTP, measured in s);
(4) Blood volume (BV, measured in ml/100 g);
(5)Mean transit time (MTT) (sec),
Along with colour maps of the five kinetic parameters, time attenuation curves (TACs) for the input artery and tumour were generated.
Good agreements were obtained between the replicated measurements (interclass correlation coefficient > 0.99)
Except for MTT and TTP, which was statistically (p <0.05) lower in malignant lesions, all CTP parameter values were significantly (P <0 .05) higher in malignant lesions when compared with the benign lesions and the background normal tissue.
When compared to normal, benign lesions showed higher BF and BV but were not statistically significant(p >0.05). MTT and TTP values in benign lesions were comparable to that of normal.
BRAIN PATHOLOGIES (n=36)
18 cases of stroke
14 brain tumors
9 cases of pituitary adenoma
6 infective lesions
HEAD & NECK PATHOLOGIES (n=98)
14 cases of Salivary gland lesions
24 cases of Buccal malignancies
9 cases of Supraglottic ca’s
11 cases of Glottic ca’s
4 cases of Infraglottic ca’s
8 cases of Thyroid lesions
15 cases of Lymphnodal lesions
13 cases of Neck infections
ESOPHAGEAL MALIGNANCIES (n=26)
7 cases of Cervical esophagus
11 cases of Thoracic esophagus
8 cases of Gastroesophageal junction
BREAST MALIGNANCIES (n=11)
9 cases of female breast ca’s
2 cases of male breast ca’s
LUNG PATHOLOGIES (n=142)
98 cases of lung malignancies
54 cases of benign lung lesions
SPINAL PATHOLOGIES (n=11)
7 cases of spinal malignancies
4 cases of benign spinal lesions
9 cases of Gastric malignancies
21 cases of Hepatic lesions
19 cases of Pancreatic lesions
2 cases of Splenic lesions
9 cases of small bowel malignancies
4 cases of Adrenal lesions
9 cases of Renal lesions
13 cases of Colonic malignancies
16 cases of Lymphomas
PELVIC PATHOLOGIES (n=42)
6 cases of urinary bladder malignancies
13 cases of rectal malignancies
6 cases of cervical malignancies
4 cases of uterine malignancies
7 cases of ovarian lesions
5 cases of prostatic malignancies
1 cases of skin malignancy
We observed that in our series many malignant tumors show clear perfusion changes that may be helpful for differentiation from benign tumors.
Although our experience is limited, we believe that perfusion CT can reveal blood flow in cases with malignancy and therefore may aid in the differentiation of the late stage fibrosis and recurrent tumor in many cases.