Inverse Correlation Between Tumor Perfusion and Glucose Uptake in Human Head and Neck Tumors

Rationale and Objectives

We sought to determine the relationship between tumor blood flow and glucose uptake in head and neck tumors using perfusion computed tomography (PCT) and fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET).

Materials and Methods

Institutional review board approval and informed consent were obtained for this study. Sixteen patients (mean age, 67 years; age range, 36–89 years) who had known or suspected head and neck tumors (15 malignant tumors and one schwannoma) underwent PCT and FDG PET examinations. Tumor area was measured on conventional CT images. The PCT data were postprocessed using maximum slope method analysis, and standardized uptake value (SUV) was measured on FDG PET.

Results

Mean arterial perfusion of the tumors was 61.56 mL/min/100 mL (range 22.17–102.7 mL/min/100 mL), and mean FDG SUV was 7.48 (range 2.74–17.1). A significant negative correlation between arterial perfusion and FDG SUV was found for malignant tumors ( r = −0.538, P = .04, n = 15).

Conclusion

There was an inverse relationship between arterial perfusion and glucose uptake of head and neck malignant tumors, suggesting that the malignant tumors may depend on anaerobic glycolysis.

Computed tomography (CT) is widely used as a noninvasive method to evaluate head and neck tumors. CT is based on anatomic information. Besides an anatomical analysis, a functional analysis of CT is also possible with use of perfusion CT (PCT) technique. Contrast-enhanced dynamic CT provides quantitative information about blood flow noninvasively. In general, the active portion of malignant tumors exhibit increases perfusion because of their neovascularization. PCT has been used to measure in vivo blood flow in various types of tumors ( ).

Positron emission tomography (PET) is also a functional imaging method. There are various PET tracers including, but not limited to, fluorine-18-fluorodeoxyglucose (FDG; 8, 9), to measure glucose uptake; fluorine-18-fluoroerythronitroimidazole (FETNIM; 10, 11) and fluorine-18-fluoromisonimidazole (FMISO; 12, 13), to measure tissue oxygenation; and [ 15 O]H 2 O ( ) to measure blood flow. Malignant tissues are hypermetabolic compared to normal tissue, and the metabolic rate of glucose is not an exception. FDG, an analog of glucose that is metabolized in viable cells by the same pathways as glucose, is known to have a higher uptake in various malignant tumors compared to normal tissue ( ).

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Materials and methods

Patients

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CT Imaging

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Arterial perfusion(mL/min/100mL)=Peak gradientof the tumortime-attenuationcurve/Peakarterial CT number increase Arterial perfusion

(

min

100

)

Peak gradient

of the tumor

time-attenuation

curve

Peak

arterial CT number increase

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FDG PET Imaging

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SUV=radioactivity concentration inthe ROI(MBq/g)/[injected dose(MBq)/patient’s body weight(g)] SUV

radioactivity concentration in

the ROI

(

MBq

)

[

injected dose

(

MBq

)

patient’s body weight

(

)

]

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Statistical Analysis

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Results

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Table 1

Values for Head and Neck Tumors

Tumor Arterial Perfusion (mL/min/100 mL) FDG SUV Area (cm 2 ) All tumors (n = 16) 61.56 ± 27.3 7.48 ± 3.61 7.00 ± 5.65 Malignant tumors (n = 15) 64.18 ± 26.04 7.57 ± 2.99 ⁎ 7.45 ± 5.88 †

Data are given as mean ± SD.

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Discussion

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Table 2

Correlation Between Arterial Perfusion and Glucose Uptake Measurement of Malignant Tumors

Study Method to Calculate Perfusion (method) Species, Organ Size No. of Cases Negative correlation Stewart et al., 2006 ( ) Dynamic CT (deconvolusion) Rabbit, liver 2.99 ± 0.9 cm 20 Fukuda et al., 2004 ( ) 15 O-PET (one-compartment model) Human, liver NA 13 Current study Dynamic CT (maximum slope) Human, head or neck 7.45 ± 5.88 cm 2 15 Positive correlation Mankoff et al., 2002 ( ) 15 O-PET (one-compartment model) Human, breast 4.9 cm, range, 1.9–11 cm 37 Tateishi et al., 2002 ( ) Dynamic CT (gamma curve fitting) Human, lung 2.6 ± 0.2 cm 40

NA, not applicable.

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Conclusion

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References

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Inverse Correlation Between Tumor Perfusion and Glucose Uptake in Human Head and Neck Tumors

Rationale and Objectives

Materials and Methods

Results

Conclusion

Materials and methods

Patients

CT Imaging

FDG PET Imaging

Statistical Analysis

Results

Discussion

Conclusion

References

Further Reading

Abstracts of Funded National Institutes of Health Grants

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