摘要：
Objective To investigate the value of 18F-FDG combined with 11C-acetate PEI/CT tar detecting newly diagnosed and recurrent HCC.Methods Fourteen patients with newly diagnosed HCC and 12 HCC patients after treatment underwent both whole body 18F-FDG PET/CT and upper abdomen 11C-acetate PET/CT imaging.For semiquantitative analysis,the tumor-to-liver (T/L) ratio was calculated by comparing the SUVmax in HCC lesions to that in adjacent normal liver tissue.Final diagnosis was determined by histopathology examination or follow-up results after more than 6 months.The correlation analysis between histopathologic differentiation and uptake of 18 F-FDG and 11C-acetate was performed with SPSS 13.0 software.T-test,analysis of variance,x2 test and Fisher exact test were used.Results For HCC patients,the overall diagnostic sensitivities of 18F-FDG,11C-acetate and the combination of the tracers were 57.7％ (15/26),61.5％ (16/26) and 92.3％ (24/26),respectively.The combined examination was superior to thesingle modality (x2=7.11 and 6.13,both P＜0.05).Uptake of 18 F-FDG in well (n=10),moderately (n=16) and poorly (n=8) differentiated tumors increased in ascending order,with the T/L ratios of 0.98±0.08 (0.8 to 1.1),1.59±0.92 (0.8 to 3.7) and 2.12±1.03 (0.7 to 3.7),respectively (F=4.52,P=0.02) ; while uptake of 11C-acetate in well and moderately differentiated HCC was higher than that in poorly differentiated HCC,with T/L ratios of 1.69 ± 0.85 ( 0.9 to 3.7 ),1.58 ± 0.47 (0.5 to 2.2) and 0.94±0.42 (0.5 to 1.8),respectively (F=4.17,P=0.03).Accordingly,the sensitivity of 18F-FDG from well to poorly differentiated HCC grades gradually increased,with the detection rate of 0(0/10),50.0％ (8/16) and 87.5％ (7/8),respectively (x2 =14.23,P＜0.05).11C-acetate exhibited a better detection rate for well and moderately differentiated HCC than for poorly differentiated HCC (70.0％ (7/10),81.2％(13/16) and 25.0％ (2/8),respectively,x2=7.56,P＜0.05).For well differentiated HCC,11C-acetate was higher in sensitivity than 18F-FDG ( P＜0.01 ),but the sensitivities for moderately and poorly differentiated HCC were not significantly different (P=0.23,0.06).Conclusions Neither single examination by 18F-FDG nor 11C-acetate has high enough detection in newly diagnosed or recurrent HCC.On the other hand,a combination examination with 11C-acetate and 18F-FDG shows excellent sensitivity in the detection of HCC and can additionally provide a hint toward the differentiated grade of HCC.%目的 研究18F-FDG和11C-乙酸盐(AC)PET/CT单独和联合显像对HCC及复发与残留灶检测的价值.方法 对14例初诊和12例经治疗的HCC患者行PET/CT全身18F-FDG和上腹部11C-AC显像,分别计算二者肿瘤与周围正常肝组织的SUVmax比值(T/L),以病理学诊断或临床随访结果为标准,分析不同分化程度HCC对18F-FDG和11C-AC的摄取差异.采用SPSS 13.0统计软件对计量资料进行t检验或方差分析,对计数资料进行x2检验或Fisher确切概率法检验.结果 以患者为单位,18F-FDG PET/CT、11C-AC PET/CT和二者联合检查的灵敏度分别为57.7％(15/26)、61.5％(16/26)和92.3％(24/26),联合检查明显优于二者单独检查(x2=7.11和6.13,P均＜0.05).高(10例)、中(16例)、低(8例)分化的HCC病灶18F-FDG摄取指标T/L比值分别为0.98±0.08(0.8～1.1)、1.59±0.92 (0.8～3.7)和2.12±1.03 (0.7～3.7),F=4.52,P=0.02;11C-AC摄取指标T/L则依次降低,分别为1.69±0.85 (0.9～3.7)、1.58±0.47 (0.5～2.2)和0.94±0.42 (0.5～1.8),F=4.17,P =0.03.18F-FDG对高、中、低分化HCC的检出率依次增高,分别为0(0/10)、50.0％(8/16)和87.5％(7/8)(x2=14.23,P＜0.05),11C-AC对高、中分化HCC的检出率明显高于低分化HCC,分别为70.0％(7/10)、81.2％(13/16)和25.0％(2/8)(X2=7.56,P＜0.05).对高分化HCC的检测,11C-AC明显优于18F-FDG(P＜0.01),对中、低分化HCC的检测,二者差异无统计学意义(P=0.23和0.06).结论 18F-FDG和11C-AC PET/CT单独检查对初诊和经治疗HCC检测的灵敏度均不够高,但二者联合检查可提高对HCC原发灶、残留及复发病灶的检出率,并能预示HCC的分化程度.
