^(18)F-FDG PET、CT和血管造影在原发性肝癌TACE后随访的对比研究  

A comparative study of ^(18)F-FDG PET, CT and angiography in the follow-up of primary liver carcinoma after transcatheter arterial chemoembolization

作　　者：商健彪[1] 刘方颖[1] 李彦豪[1] 裴著果[2] 

机构地区：[1]第一军医大学南方医院,广东广州510515 [2]中国医科大学附属第二医院核医学科,辽宁沈阳110004

出　　处：《中国临床医学影像杂志》2004年第9期509-512,529,共5页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨18F-FDGPET、CT和血管造影对原发性肝癌TACE后残留及转移病灶的检出能力。材料与方法:80例经穿刺活检或手术病理证实的肝癌患者,其中高分化肝细胞癌20例、中分化肝细胞癌44例、低分化肝细胞癌11例、肝胆管细胞癌3例、肝腺癌2例。以临床随访6个月以上及部分病理结果为标准,回顾性分析TACE后1.5～2个月18F-FDGPET、CT和血管造影对肿瘤残留及转移病灶的显示情况。结果:80例患者肝内共104个病灶,经临床随访6个月以上及部分病理结果证实,有肿瘤残留病灶62个,PET正确检出56个,CT正确检出38个,血管造影正确检出58个;无肿瘤残留病灶42个,PET正确检出40个,CT正确检出40个,血管造影正确检出42个。PET和血管造影对肝癌TACE后肿瘤残留病灶检出的灵敏度和准确性分别为90.3%、92.3%和93.6%、96.2%,明显高于CT(61.3%、75.0%),差异显著(P<0.01)。同时PET检出了CT和血管造影无法发现的肝外转移病灶5例。结论:CT是肝癌TACE后最常用的随访方法,可以清晰显示碘油在病灶内的分布情况。18F-FDGPET显像能够更加准确的鉴别肿瘤存活,特别是CT无法明确的病变,而且对于肝外转移病灶的检出具有独特的优势。血管造影的诊断灵敏度、准确性最高,但是属于有创性检查。将多种影像学方法相结合,能够为临床提供更加可靠的定位和定?Objective: To evaluate the value of 18F-fluorodeoxyglucose(FDG) PET imaging, CT and angiography for detecting residual and metastatic lesions of primary liver carcinoma after transcatheter arterial chemoembolization(TACE). Materials and Methods: Twenty cases of well-differentiated hepatocellular carcinoma(HCC), 44 cases of moderately differentiated HCC, 11 cases of poorly-differentiated HCC, 3 cases of hepatocholangiocarcinoma and 2 cases of hepatoadenocarcinoma in 80 patients were proved by biopsy or histologic examination. A retrospective analysis of detecting residual and metastatic lesions with PET, CT and angiography was performed after TACE during 1.5～2 months. PET, CT and angiography findings were compared on the basis of clinical follow-up and histologic examination. Results: One hundred and four lesions were found in 80 patients. Sixty-two lesions with and the other 42 lesions without residual viable tumor were confirmed by the clinical follow-up and histologic examination. Fifty-six lesions with and 40 without residual viable tumor were found on PET, and PET displayed 90.3% sensitivity, 92.3% accuracy. Thirty-eight lesions with and 40 lesions without residual viable tumor were found on CT, and its sensitivity and accuracy were 61.3% and 75.0%. Fifty-eight lesions with and 42 without residual viable tumor were found on angiography, and angiography displayed 93.6% sensitivity, 96.2% accuracy. The sensitivity and accuracy between PET, angiography and CT in evaluating the residual viable tumor of HCC after TACE were significantly different(P<0.01). Five cases with extrahepatic metastasis were found by PET, which were not detected through CT and angiography. Conclusion: CT is the commonest imaging modality in the follow-up of primary liver carcinoma, which can demonstrate the patterns of lipiodol deposited within lesions. 18F-FDG PET imaging can detect activity of tumor, especially in those residual viable lesions that can not be detected by CT. PET has advantage of detecting extrahepatic metastasis also.

关 键 词：肝肿瘤 脱氧葡萄糖 血管造影术 药物疗法 联合 体层摄影术 X线计算机 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学]