What is CT perfusion and how does it help in understanding lung cancer?

CT perfusion, or CTp, is a promising imaging technology that offers high-resolution spatial and temporal data of a tumor. By analyzing time-concentration curves (TCCs), which are generated as a contrast agent reaches the tumor, CTp helps compute perfusion parameters. These parameters provide insights into the tumor's blood supply, aiding in the characterization of different tissues. It's especially valuable in cases where patients aren't eligible for surgery, but need non-surgical treatment. CT Perfusion can also help differentiate between the two major types of non-small cell lung cancer, adenocarcinoma and squamous cell carcinoma.

Why is measuring blood flow important in lung cancer?

Blood flow (BF) is an important perfusion parameter for evaluating angiogenesis, which is the creation of new blood vessels vital for tumor growth. BF has a strong correlation with microvessel density (MVD), a key tissue biomarker. Measuring BF involves tracking the initial passage of a contrast medium, allowing for quick examinations that minimize radiation exposure. Higher baseline BF values in advanced lung cancer patients may also indicate a better response to specific therapies. Also the difference in BF values between patients who respond to treatment and those who do not have spurred interest in characterizing tumors based on their hemodynamic properties, including their histological subtypes.

What is angiogenesis, and why is it important in cancer?

Angiogenesis is the process by which new blood vessels are formed. It is crucial because tumors need a blood supply to grow and spread. Blood flow provides oxygen and nutrients necessary for tumor cells to proliferate. This process can be a target for cancer therapy. The differences in angiogenesis between adenocarcinoma and squamous cell carcinoma suggest that antiangiogenic therapies may be more effective for adenocarcinoma, which typically has higher blood flow.

What are adenocarcinoma and squamous cell carcinoma, and how do they differ in terms of blood flow?

Adenocarcinoma (AC) and squamous cell carcinoma (SCC) are the two most common types of non-small cell lung cancer (NSCLC). Research indicates that they exhibit different blood flow patterns. One study showed that at diagnosis, the mean blood flow values for AC were significantly higher than those for SCC. These differences can be used to guide treatment planning, especially when selecting AC patients who would benefit most from antiangiogenic therapies. Characterizing non-small cell lung cancer (NSCLC) perfusion can provide valuable insights into a tumor's status, especially regarding its hypoxia (oxygen deficiency).

How was blood flow measured in the study, and what were the key findings regarding adenocarcinoma and squamous cell carcinoma?

The study used CT perfusion to measure blood flow in patients diagnosed with non-small cell lung cancer (NSCLC). By computing blood flow (BF) values and automatically removing unreliable values (e.g., artifacts or vessels), the study found that adenocarcinoma (AC) had significantly higher blood flow than squamous cell carcinoma (SCC) at diagnosis. This finding suggests that blood flow can be a valuable biomarker for differentiating between these two types of lung cancer, which can help tailor treatment strategies.

Illustration of lung cancer cells showing different blood flow patterns.

Lung Cancer Blood Flow: What Your Doctor Needs to Know

Reese Marlowe in Health & Wellness December 2025 • 5 min read.

"New research unveils how different types of lung cancer—squamous cell carcinoma and adenocarcinoma—show unique blood flow patterns, potentially transforming treatment strategies."

Angiogenesis, the creation of new blood vessels, is vital for tumor growth. By studying these vascular patterns, doctors can better understand and characterize different tissues. CT perfusion (CTp) is a promising technology that provides high-resolution spatial and temporal data, which helps in computing perfusion parameters by analyzing time-concentration curves (TCCs). These curves are generated as a contrast agent reaches the tumor, offering insights into its blood supply.

One of the most valuable perfusion parameters for evaluating angiogenesis is blood flow (BF). BF has a strong correlation with microvessel density (MVD), a key tissue biomarker. Measuring BF involves tracking the initial passage of a contrast medium, allowing for quick examinations that minimize radiation exposure. Clinically, BF information obtained at diagnosis can help characterize lesions, particularly in patients who are not eligible for surgery but need non-surgical treatments. Higher baseline BF values in advanced lung cancer patients may also indicate a better response to specific therapies.

Differences in BF values between patients who respond to treatment and those who do not have spurred interest in characterizing tumors based on their hemodynamic properties, including their histological subtypes. Characterizing non-small cell lung cancer (NSCLC) perfusion can provide valuable insights into a tumor's status, especially regarding its hypoxia (oxygen deficiency). Adenocarcinoma (AC), for instance, typically has a lower degree of hypoxia compared to squamous cell carcinoma (SCC). By understanding these differences, treatments can be tailored to improve outcomes.

Decoding Blood Flow in Lung Cancer: Adenocarcinoma vs. Squamous Cell Carcinoma

Illustration of lung cancer cells showing different blood flow patterns.

A recent study aimed to evaluate the distinct characteristics of lung tumors at diagnosis, focusing on potential differences in perfusion between adenocarcinoma (AC) and squamous cell carcinoma (SCC), the two most common NSCLC phenotypes. Previous research has presented conflicting results in AC and SCC perfusion characterization due to high measurement variability from clinical, physiological, and external factors (like patient movement and artifacts). To mitigate this variability, the study used an automatic method to detect and remove unreliable perfusion values.

Researchers also looked at the position of lesions (central or peripheral) and their proximity to large vessels to understand how these external factors might artificially affect histotype perfusion. Additionally, they analyzed less representative lesions for each histotype, where perfusion values shifted closer to the mean value characterizing the other histotype.

Study Design: The study involved 26 patients with primary NSCLC (19 AC and 7 SCC) who underwent CT perfusion at diagnosis.
Data Collection: BF values were computed using the maximum-slope method, and unreliable values (e.g., those arising from artifacts or vessels) were automatically removed.
Statistical Analysis: A one-tail Welch’s t-test was used to assess statistical significance, with a p-value < 0.05 indicating significance.

The study revealed that at diagnosis, the mean BF values for AC (83.5 ± 29.4 mL/min/100g) were significantly higher than those for SCC (57.0 ± 27.2 mL/min/100g), with a p-value of 0.02. However, two central SCC cases showed artificially increased mean BF due to artifacts from the vena cava and pulmonary artery. These findings suggest that the differing hemodynamic behaviors of AC and SCC should be considered as biomarkers to guide treatment planning, particularly in selecting AC patients who would benefit most from antiangiogenic therapies. The ability to automatically detect and exclude artefactual BF values was crucial in achieving these significant results.

Future Implications for Lung Cancer Treatment

This research underscores the importance of understanding the unique blood flow characteristics of different lung cancer subtypes. By using CT perfusion to identify these patterns, doctors can make more informed decisions about treatment strategies, especially regarding antiangiogenic therapies for adenocarcinoma. Further studies are needed to explore these findings in larger patient cohorts and to investigate additional factors that may influence perfusion values. The ability to accurately profile tumors based on their perfusion characteristics holds great promise for personalized medicine in lung cancer treatment.