18F-FDG PET/CT对高18F-FDG摄取肝细胞肝癌经动脉插管化疗栓塞的疗效评价

摘要

Objective To evaluate the therapeutic response of transcatheter hepatic arterial chemoembolization (TACE) for primary HCC using 18 F-FDG PET/CT.Methods Twenty-four HCC patients (21males,3 females; age range:40 to 75 years,mean age:58.1 years) with high uptake of 18F-FDG on pretreatment PET/CT and with follow-up 18F-FDG PET/CT 1-2 months post TACE were retrospectively analyzed.A lesion was regarded as positive for HCC if it had higher FDG uptake than the surrounding liver parenchyma.All patients were followed for 3 months by clinical symptoms,AFP and 18F-FDG PET/CT.x2 test was used to analyze the difference between the diagnostic value of 18F-FDG PET/CT and AFP.Results On follow-up 18F-FDG PET/CT,9 patients had lower 18F-FDG uptake than the surrounding liver parenchyma,indicating no residual tumor; while 11 patients with residual tumor showed higher uptake of FDG than the liver background though the uptake was lower than that of baseline PET/CT.Two patients with isometabolic FDG uptake were confirmed of having residual tumor during follow-up.One case showed increased 18F-FDG uptake more than that of baseline,indicating disease progression.One case was false positive for residual tumor due to over attenuation correction in the presence of lipiodol.The sensitivity and accuracy for the detection of residual tumor by 18F-FDG PET/CT and AFP were 100％ (14/14) vs 71.4％ (10/14),and 95.8％(23/24) vs 70.8％(17/24) (x2 =6.56 and 4.18,both P＜0.05),respectively.Conclusion 18F-FDG PET/CT is useful to evaluate the efficacy of TACE for 18F-FDG-avid HCC and it may provide important information for further treatment planning.%目的 探讨18F-FDG PET/CT对高18F-FDG摄取的原发性HCC经动脉插管化疗栓塞术(TACE)治疗后的疗效评价价值.方法 回顾性分析24例经临床证实、且18F-FDG代谢增高的原发性HCC,经TACE治疗后行PET/CT复查的患者资料,其中男21例,女3例,年龄为40～75(平均58.1)岁.患者均在治疗后1～2个月行肝脏局部18F-FDG PET/CT复查,观察病灶治疗后18F-FDG的代谢变化.将病灶区的FDG SUVmax高于周围正常肝实质者定义为病理性的FDG代谢.以PET/CT复查后随访(临床症状、AFP、PET/CT检查结果)3个月结果为标准,计算复查对残留肿瘤组织的诊断效能,并采用x2检验分析PET/CT与AFP诊断效能的差异.结果 24例中有9例呈FDG代谢减低区(相对于正常肝实质而言),提示无残留肿瘤组织；11例仍呈FDG代谢增高,但代谢活性较治疗前降低,提示残留肿瘤组织；2例FDG代谢等同于正常肝组织,但随访证实为肿瘤残留；1例病灶FDG代谢活性较治疗前增高,提示病情进展；1例由于高密度碘油的过度衰减校正导致假阳性.18F-FDG PET/CT评价原发性HCC TACE治疗后残留病灶的灵敏度及准确性分别为100％ (14/14)、95.8％ (23/24),与单独以血清AFP为评价指标的灵敏度(71.4％,10/14)及准确性(70.8％,17/24)之间的差异有统计学意义(x2=6.56和4.18,均P＜0.05).结论 18F-FDG PET/CT对摄取18 F-FDG的原发性HCC患者的TACE治疗疗效评价有较大价值,可提供残留病灶的准确位置,为临床确定后续的治疗方案提供依据.