Objectives: To apply molecular and functional imaging to the pre-treatment assessment of disease using combined Dynamic Contrast enhanced CT (DCECT) and 18 Fluoride- Fluorodeoxyglucose -positron emission tomography computed tomography ( 18 F –FDG PET), in lung carcinoma to define the cancer phenotype. Methods: Seventy four consecutive patients with potentially curable lung cancer were prospectively recruited for combined positron 18 F-FDG PET/DCECT using an integrated 64-detector PET/CT. There were 10 technical failures leaving a study population of 64 patients (35 males; 29 females. Mean age 67.5). Studies were using an integrated 64-detector PET/CT. The uptake of 18 F-FDG quantified as the Standard Uptake Value (SUVmax) assessed tumor metabolism. Results: The mean tumor SUVmax, PE and SPV were 13.8, 37.6 HU and 6.5. No statistically significant relationships between tumor metabolism and vascular parameters. There were significant associations between tumor size and vascular-metabolic parameters- SUVmax v size ( r = 0.4, p = 0.001), SUV/PE v size ( r =0.4, p <0.001), SUVmax/SPV v size ( r =0.4, p <0.001). SUVmax and SUV/PE were higher in SCC than in adenocarcinoma (17.4 versus11.8; p =0.026 and 0.57 versus 0.35, p =0.021 respectively). A phenotype with low metabolism and high vascularity was significantly more common amongst adenocarcinomas (p<0.01), whilst high metabolism with high vascularity was more common amongst SCC (P<0.005). Conclusion: V ascularity and metabolism are uncoupled in NSCLC. Since some lung cancer patients have inadequate tissue sampling metabolic flow data could be helpful clinically in managing lung cancer patients to targeted therapy using non-invasive 18 F-FDG PET/DCECT scan.
Win et al. (Thu,) studied this question.