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CT Perfusion for Determination of Pharmacologically Mediated Blood Flow Changes in an Animal Tumor Model¹

¹ From the Laboratory for Minimally Invasive Tumor Therapy (A.H., H.P., A.U.H., S.L., S.N.G.), Department of Radiology (A.U.H., C.J.W., J.K., V.D.R., S.N.G.), Beth Israel Deaconess Medical Center, 1 Deaconess Rd, WCC 308B, Boston, MA 02215; and the Department of Interventional Radiology, Gustave Roussy Cancer Institute, Villejuif, France (T.d.B.). Received December 15, 2005; revision requested February 9, 2006; revision received June 1; accepted June 21; final version accepted September 22. Supported by National Cancer Institute Dana Farber/Harvard Cancer Center Renal Cancer SPORE grant 1 P50 CA10194-01. Address correspondence to S.N.G. (e-mail: sgoldber{at}caregroup.harvard.edu).

View larger version (26K): [in this window] [in a new window] [Download PPT slide]   Figure 1: CT perfusion images show the effect of arsenic trioxide. CT perfusion was used to calculate the drop in tumor blood flow, and measurements were correlated with those obtained with the laser Doppler fiber inserted at the tumor periphery (arrow), as shown on, A, the gray-scale image. For all transverse images, the region that represented the subcutaneous tumor was encircled by the region of interest. Image obtained, B, at baseline shows mean blood flow of 21.9 mL/min; whereas image obtained, C, 1 hour after administration of arsenic trioxide (5 mg/kg) shows blood flow was 14.8 mL/min (a 32.4% decrease).

View larger version (81K): [in this window] [in a new window] [Download PPT slide]   Figure 2: Transverse single-section CT perfusion images show heterogeneity of results between sections. At baseline, mean blood flow for the four 5-mm sections (covering the entire tumor) ranged from 12.31 to 25.33 mL/min (mean, 18.7 mL/min).

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: (a, b) Graphs show correlation between blood flow changes at CT perfusion and laser Doppler flowmetry. Results for both observers are shown for single- and multisection techniques. When the accuracy of single- and multisection CT techniques used to calculate decreases in blood flow was compared with that of laser Doppler flowmetry, good correlations were achieved for both techniques. Lines represent the relationship between the reference standard and the single- or multisection technique for each observer.

View larger version (17K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: (a, b) Graphs show correlation between blood flow changes at CT perfusion and laser Doppler flowmetry. Results for both observers are shown for single- and multisection techniques. When the accuracy of single- and multisection CT techniques used to calculate decreases in blood flow was compared with that of laser Doppler flowmetry, good correlations were achieved for both techniques. Lines represent the relationship between the reference standard and the single- or multisection technique for each observer.

View larger version (4K): [in this window] [in a new window] [Download PPT slide]   Figure 4a: (a, b) Interreader agreement for percentage of change in blood flow measured with perfusion CT. Bland-Altman plots show that when each observer was allowed to select the section that he or she thought was most representative of the tumor, there was significantly greater interobserver variability (SD, 0.22) for the single-section technique than for the multisection technique (SD, 0.10; P = .01). Bars represent mean differences, and corresponding 95% confidence intervals are shown.

View larger version (4K): [in this window] [in a new window] [Download PPT slide]   Figure 4b: (a, b) Interreader agreement for percentage of change in blood flow measured with perfusion CT. Bland-Altman plots show that when each observer was allowed to select the section that he or she thought was most representative of the tumor, there was significantly greater interobserver variability (SD, 0.22) for the single-section technique than for the multisection technique (SD, 0.10; P = .01). Bars represent mean differences, and corresponding 95% confidence intervals are shown.