^(18)F-FDG PET/CT检查指标预测肝细胞癌微血管侵犯临床价值研究  

Clinical value of ^(18)F-FDG PET/CT scan in patients with hepatocellular carcinoma and hepatic microvascular invasion

作　　者：幸奠奎[1] 程婧 Xing Diankui;Cheng Jing(Department of Nuclear Medicine,Zhongnan Hospital,Wuhan University,Wuhan 430071,Hubei Province,China)

机构地区：[1]武汉大学中南医院核医学科,武汉市430071 [2]武汉大学中南医院放射科,武汉市430071

出　　处：《实用肝脏病杂志》2019年第2期252-255,共4页Journal of Practical Hepatology

基　　金：湖北省自然科学基金资助项目(编号:256382)

摘　　要：目的研究^(18)氟-代脱氧葡萄糖电子发射断层显像术/x线计算机体层摄影术(18F-FDG PET/CT)检查预测肝细胞癌(HCC)微血管侵犯(MVI)患者的临床意义。方法 2014年2月～2015年12月我院诊治的HCC患者99例,接受^(18)F-FDG PET/CT检查,然后行肝叶切除术。结果在99例HCC患者中,经术后组织病理学检查,证实有MVI患者42例,无MVI患者57例;^(18)F-FDG PET/CT检查结果显示,肝内肿瘤表现为低密度或稍低密度阴影,病灶呈不规则状,大多数情况呈类圆形,部分肿瘤周围伴有子灶。PET/CT检查显像阳性73例(73.7%),其中MVI阳性组为85.7%,显著高于MVI阴性组的64.9%(P<0.05);MVI阳性组肿瘤直径为(7.6±2.8) cm,显著大于MVI阴性组的(5.4±2.4) cm,肿瘤最大标准摄取值(SUVmax)为(7.4±5.2),显著高于MVI阴性组的【(5.3±5.2),P<0.05】;MVI阳性与MVI阴性患者肿瘤组织学类型差异无统计学意义(P>0.05),但MVI阳性患者肿瘤分化为II-I/IV型比例显著高于MVI阴性患者(88.1%对75.4%,P<0.05);术后随访12～24个月,中位随访时间为18个月,99例HCC患者1 a总体生存率为81.8%,无瘤生存率为60.6%,其中MVI阳性组1 a总体生存率和无瘤生存率分别为66.7%和47.6%,显著低于MVI阴性组的91.2%和70.2%(P<0.05)。结论肝细胞癌伴有微血管侵犯患者在行18F-FDG PET/CT检查时有一些特点值得总结和观察,其临床意义还需要进一步探讨。Objective To explore the clinical value of^18F-FDG PET/CT scan in patients with hepatocellular carcinoma(HCC)and hepatic microvascular invasion(MVI).Methods We retrospectively analyzed the clinical materials of 99 patients with HCC who admitted to our hospital between February 2014 and December 2015.All these 99 patients received^18F-FDG PET/CT scan and hepatectomy thereafter,and the postoperative histopathological examination was done to confirm the existence of MVI.Results Out of the 99 patients with HCC,the postoperative pathological examination showed the existence of MVI in 42,and without MVI in 57 cases;the^18F-FDG PET/CT scan showed that the intrahepatic tumor irregular and mostly rounded,some accompanied by subfoci,presenting with low density or slightly low density shadows.The PET/CT examination was positive in 73(73.7%)cases,85.7%in patients with MVI,and 64.9%in patients without MVI(P<0.05);the tumor diameter in patients with MVI positive was(7.6±2.8)cm,significantly larger than(5.4±2.4)cm in patients without MVI,and the tumor maximum standardized uptake value(SUVmax)was(7.4±5.2),significantly higher than【(5.3±5.2),P<0.05】in patients with MVI negative;the histological types of hepatocellular carcinoma in patients with and without MVI were not significantly different(P>0.05),while the percentage of tumor differentiation type III/IV was much higher in patients with MVI as compared to that in patients without(88.1%vs.75.4%,P<0.05);all the patients were followed-up for 12 to 24 months with the median of 18 months,the one-year total survival was 81.8%and the disease-free survival rate was 60.6%;further analysis showed that the one-year survival and one-year disease-free survival rate in patients with MVI positive were 66.7%and 47.6%,significantly lower than 91.2%and 70.2%,respectively(P<0.05)in patients with MVI negative.Conclusions The patients with hepatocellular carcinoma and hepatic microvascular invasion have some characteristics when the^18F-FDG PET/CT scan is done,which should be summarized an

关 键 词：肝细胞癌 18F-FDG PET/CT 微血管侵犯 生存率 

分 类 号：R735.7[医药卫生—肿瘤] R730.44[医药卫生—临床医学]