介入治疗后AFP升高的肝癌患者^(18)F-FDG PET/CT显像与增强CT的对比  

Value of ^(18)F-FDG PET/CT in serum α-fetoprotein elevation of hepatocellular carcinoma patients after TACE:Compared with contrast-enhanced CT

作　　者：梁英魁[1] 川玲[1] 赵文锐[1] 方庭正[1] 王升[1] 朱家瑞[1] 

机构地区：[1]中国人民解放军海军总医院核医学科PET/CT中心,北京100048

出　　处：《中国介入影像与治疗学》2010年第5期515-519,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的比较18F-FDG PET/CT与增强CT(CECT)在评估经导管肝动脉化疗栓塞术(TACE)治疗后甲胎蛋白(AFP)升高的原发性肝癌(HCC)患者中的价值。方法回顾性分析42例TACE后近期AFP升高HCC患者的18F-FDGPET/CT与CECT扫描表现。结果由手术活检、血管造影及临床随访(最短随访3~6个月)证实。在PET/CT首次显像(60min)和延迟显像时(120min)测量肝内病灶区的最大标准摄取值(SUVmax);SUV比值(SUVratio)=肿瘤区最大SUV值/非肿瘤肝组织的平均SUV值。比较18F-FDG PET/CT与CECT的灵敏度与准确率以及PET/CT首次显像与延迟显像时病灶区的SUVmax值与SUVratio。统计学分析采用χ2检验与配对t检验,以P<0.05为差异有统计学意义。结果 38例复发或转移(手术及活检病理证实10例、血管造影证实14例,临床随访确诊证实14例),4例临床随访正常。其中18F-FDG PET/CT灵敏度为92.11%(35/38)、准确率为90.48%(38/42);CECT的敏感度为73.68%(28/38)、准确率为73.81%(31/42)。两者间差异均有统计学意义(敏感度χ2=4.55,P=0.033;准确率χ2=3.98,P=0.046)。肝内病灶的早期相与延迟相SUVmax分别为4.5±1.5、4.7±1.6,差异无统计学意义(t=-0.981,P=0.341)。SUVratio分别为2.0±0.7、2.3±0.8,两者间差异有统计学意义(t=-2.591,P=0.019)。结论 18F-FDG PET/CT代谢显像能够很好地揭示肝癌患者介入治疗后AFP升高的原因,尤其在碘化油沉积较密实而CECT阴性的患者优于CECT。PET/CT延迟相可更好地显示肝内病灶。Objective To compare the value of 18F-FDG PET/CT with contrast-enhanced CT（CECT）in hepatocellular carcinoma（HCC）with serum α-fetoprotein（AFP）elevation after transcatheter arterial chemo-embolization（TACE）.Methods The findings of 18F-FDG PET/CT and CECT in 42 patients which had AFP elevation after TACE recently were studied retrospectively.The results were proved by biopsy,surgery,angiography and clinical follow-up（shortest follow-up period after PET/CT was 3—6 months）.The maximum standardized uptake value（SUVmax）of tumors and the SUVratio（SUVratio=SUVmax of tumor/SUVmean of normal liver areas）were measured at early phase（60 min）and delay phase（120 min）respectively on PET/CT.The sensitivity and accuracy were compared between PET/CT and CECT.For statistical analysis,Chi-square test and paired t-test were used.P value less than 0.05 would have significant difference.Results There were 38 patients with recurrence lesions or new metastases（10 patients were confirmed by surgery and biopsy,14 were confirmed by angiography and 14 were confirmed by clinical follow-up）.Four patients were normal with clinical follow-up.The sensitivity and accuracy was 92.11%（35/38）and 90.48%（38/42）by 18F-FDG PET/CT,and was 73.68%（28/38）and 73.81%（31/42）by CECT.There were statistical differences between PET/CT and CECT（χ2=4.55,P=0.033;χ2=3.98,P=0.046,respectively）.No statistical difference of SUVmax was found between early phase and delay phase（4.5±1.5 vs 4.7±1.6,t=-0.981,P=0.341）,but there were significant statistical differences with SUVratio（2.0±0.7 vs 2.3±0.8,t=-2.591,P=0.019）.Conclusion 18F-FDG PET/CT is a valuable imaging tool better than CECT in HCC patients which have AFP elevation after TACE,especially in dense lipiodol retention lesions.The delay phase images can display the lesions better on PET/CT.

关 键 词：癌 肝细胞 体层摄影术 X线计算机 正电子发射型体层摄影术 氟脱氧葡萄糖F18 甲胎蛋白 

分 类 号：R735.7[医药卫生—肿瘤]