title: Role of perfusion CT in assessing tumor blood flow and malignancy level of gastric cancer.
abstract: OBJECTIVE
  Intratumoral hemodynamics or tumor perfusion is useful in understanding the pathological background of the cancer. A parameter for a non-invasive, preoperative assessment of tumor perfusion has yet to be developed.
  
  
  METHODS
  The study included 50 patients who underwent surgery for gastric cancer. Perfusion computed tomography (P-CT) was performed using a 16-row multidetector CT, and tumor blood flow (ml/min/100 g tissue) values were measured. We compared blood flow with histopathological characteristics and evaluated its correlation with microvessel density and tumor stromal density and calculated the ratio of vessels and stromal tissue.
  
  
  RESULTS
  There was a significant decrease in blood flow in advanced tumor depth, peritoneal dissemination and undifferentiated subtypes. Cases with Lauren's diffuse type carcinoma were found to have decreased blood flow compared to the mixed or intestinal type. As for the stromal structure, despite the lack of correlation with microvessel density, blood flow significantly decreased with increased stromal density.
  
  
  CONCLUSIONS
  Decreased blood flow value acquired from P-CT may reflect a progressive state of gastric cancer. The pathological background for this relation involves the tumor stroma. Tumor perfusion decreased as the stage and malignant character of the tumor advanced, and therefore P-CT could be a better strategy to estimate the malignancy level of cancer.
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan. samasami@goo.jp
authors.forename: Asami
authors.initials: A
authors.lastname: Satoh
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Shuto
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okazumi
authors.forename: Gaku
authors.initials: G
authors.lastname: Ohira
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Natsume
authors.forename: Koichi
authors.initials: K
authors.lastname: Hayano
authors.forename: Kazuo
authors.initials: K
authors.lastname: Narushima
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Saito
authors.forename: Takumi
authors.initials: T
authors.lastname: Ohta
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nabeya
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yanagawa
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D010477:Perfusion; D011857:Radiographic Image Interpretation, Computer-Assisted; D012039:Regional Blood Flow; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*