RT Journal Article SR Electronic T1 The Flow–Metabolic Phenotype of Primary Colorectal Cancer: Assessment by Integrated 18F-FDG PET/Perfusion CT with Histopathologic Correlation JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 687 OP 692 DO 10.2967/jnumed.111.098525 VO 53 IS 5 A1 Vicky Goh A1 Alec Engledow A1 Manuel Rodriguez-Justo A1 Manu Shastry A1 Jacquie Peck A1 Glen Blackman A1 Raymondo Endozo A1 Stuart Taylor A1 Steve Halligan A1 Peter Ell A1 Ashley M. Groves YR 2012 UL http://jnm.snmjournals.org/content/53/5/687.abstract AB The aim of this study was to assess the in vivo flow–metabolic phenotype in primary colorectal cancer with integrated 18F-FDG PET/perfusion CT and its relationship to gold standard histopathologic assessment of angiogenesis and hypoxia. Methods: 45 patients (26 male and 19 female; mean age, 67.6 y) with primary colorectal cancer underwent integrated 18F-FDG PET/perfusion CT, deriving tumor glucose metabolism (maximum standardized uptake value) and regional blood flow. From this cohort, 35 underwent surgery subsequently, without intervening neoadjuvant treatment, allowing histopathologic correlation with tumor stage, CD105 microvessel density, vascular endothelial growth factor (VEGF), glucose transporter protein 1 (Glut-1), and hypoxia-inducible factor 1 expression. Results: The flow–metabolic ratio was significantly lower for tumors with higher VEGF (3.65 vs. 5.98; P = 0.01) or hypoxia-inducible factor 1 expression (3.63 vs. 5.48; P = 0.04) versus tumors with lower expression. There were significant negative correlations between the tumor flow–metabolic ratio and VEGF expression (r = −0.55, P = 0.0008), indicating that tumors with low blood flow but higher metabolism were associated with higher VEGF expression. Flow and metabolism were coupled in higher-stage (stage III/IV) tumors but not lower-stage tumors (stage I/II) (r = 0.47, P = 0.03, vs. r = 0.09, P = 0.65, respectively. Conclusion: Tumors with a low-flow–high-metabolism phenotype demonstrated higher VEGF expression and may reflect a more angiogenic phenotype.