Feasibility of assessing pulmonary blood volume using C-arm CT during transpulmonary chemoperfusion and chemoembolization in primary and secondary lung tumours

OBJECTIVE: Assessment of parenchymal blood volume (PBV) of primary and secondary pulmonary malignancies by using a C-arm CT, regarding its role in detecting early functional response to transpulmonary chemoembolization (TPCE) and clinical practicability.

METHODS: 21 patients with a mean age of 56.77 years, who were assigned to TPCE during their palliative treatment, were included. PBV and the diameter of tumours were analyzed. PBV maps were calculated from three-dimensional CT-angiographic (3D-CTA) data sets. Imaging was performed on a flat detector, C-arm CT. Groups of response were classified according to the criteria of the response evaluation criteria in solid tumours. Statistically significant differences were determined and Pearson's regression analysis correlated PBV and diameter as parameters of response to treatment.

RESULTS: During 4.91 sessions, median diameter increased 18.18% (p > 0.05) and PBV reduced 39.62% (p > 0.05). Functional and imaging response per tumour was statistical significantly different (p ≤ 0.05). Correlation coefficient was r = 0.058. 2/41 tumours showed partial response; 31/41 tumours showed stable disease; and 8/41 tumours showed progressive disease. The highest pre-treatment PBV values were measured in decreasing tumours (206.93 ml l(-1)), and the lowest values were measured in increasing tumours (60.17 ml l(-1); p > 0.05). The lowest values were also measured in lung cancer (53.02 ml l(-1)) that was significantly different to uterine leiomyosarcoma (103.31 ml l(-1)) and renal cell cancer (113.14 ml l(-1); p ≤ 0.05).

CONCLUSION: Assessment of PBV maps by using 3D-CTA image data is feasible in the clinical routine. PBV shows a stronger response to TPCE treatment than measurement in diameter and should be considered as a response parameter for early detection.

ADVANCES IN KNOWLEDGE: Assessment of PBV using C-arm CT during TPCE is a feasible technique. Assessment of PBV might be useful in assessing response to treatment.