Role of perfusion CT in assessing tumor blood flow and malignancy level of gastric cancer.
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.
Satoh
Asami
A
Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan. samasami@goo.jp
Shuto
Kiyohiko
K
Okazumi
Shinichi
S
Ohira
Gaku
G
Natsume
Toshiyuki
T
Hayano
Koichi
K
Narushima
Kazuo
K
Saito
Hiroshige
H
Ohta
Takumi
T
Nabeya
Yoshihiro
Y
Yanagawa
Noriyuki
N
Matsubara
Hisahiro
H
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*