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Assessment of Inter- and Intrapatient Variability in C¹⁵O₂ Positron Emission Tomography Measurements of Blood Flow in Patients with Intra-abdominal Cancers

Department of Cancer Medicine, MRC Cyclotron Unit, Imperial College London, Hammersmith Hospital, Hammersmith, London, United Kingdom

ABSTRACT

Purpose: The aim of the study was to evaluate the inter- and intrapatient variability of positron emission tomography (PET) measurements of perfusion in advanced solid cancers.

Experimental Design: Thirty-seven patients with predominantly intra-abdominal tumors underwent PET imaging using inhaled C¹⁵O₂. Repeat data were obtained by scanning five patients twice, 1 week apart, with no intervening therapy. Regional flow and the volume of distribution (V_d) were measured from dynamic images by use of a one-compartment model. Inter- and intrapatient variability were measured as the coefficient of variability (CV). Data were also obtained for regions of interest in normal liver, spleen, and kidney.

Results: The mean (±SD) regional flow in the tumors was 0.46 ± 0.19 ml_blood/min/ml_tissue, and the mean V_d was 0.74 ± 0.15 ml_blood/ml_tissue. Variability in tumor flow was greater between (n = 37; CV = 41%) than within (n = 5; CV = 11%) patients. Variability in tumor V_d was greater between (CV = 21%) than within (CV = 6%) patients. There was a good correlation between the repeat tumor data for both regional flow ( = 0.82; P = 0.023) and V_d ( = 0.89; P = 0.007). Normal tissue variability was also greater between than within patients. In all cases, no statistically significant differences were seen between repeat measurements in the same patient.

Conclusions: Dynamic C¹⁵O₂ PET measurements of regional flow are reproducible in patients with predominantly intra-abdominal malignancies and may be useful for the pharmacodynamic evaluation of novel antivascular and antiangiogenic cancer therapeutic agents.

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