18F-FDG PET/CT代谢负荷参数在肝癌肝移植术前评估中的价值分析  

The clinical value of 18F-FDG PET/CT metabolic parameters in the assessment of liver cancer prior to liver transplantation

作　　者：丁恩慈[1] 陆东燕[1] 胡天鹏 孙茉茉 冯学民[1] 沈婕[1] Ding Enci;Lu Dongyan;Hu Tianpeng;Sun Momo;Feng Xuemin;Shen Jie(Department of Nuclear Medicine,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院核医学科,天津300192

出　　处：《实用器官移植电子杂志》2020年第5期342-348,共7页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的旨在通过分析总结肝癌肝移植患者的临床病例特点及PET/CT代谢参数探讨18F-FDG PET/CT在肝移植术前评估中的价值。方法回顾性分析2013年10月—2017年5月术前及术后均在天津市第一中心医院行18F-FDG PET/CT的肝癌肝移植患者共96例。用TrueD软件测量或计算正常肝实质、肝癌病灶及纵隔的最大标准化摄取值SUVmax(maximum standardized uptake value,SUV),病灶的瘦体标准摄取值(SUV normalized to lean body mass,SUL),肿瘤代谢体积(metabolic tumor volume,MTV)、肿瘤-纵隔摄取比(tumor-to-mediastinum SUV ratio,TMR)、肿瘤-正常肝摄取比(tumor-to-normal liver SUV ratio,TLR)、糖酵解总量(total lesion glycolysis,TLG)等代谢参数。代谢参数与临床因素的相关性分析及预测病理指标的价值采用单因素方差分析(ANOVA),代谢参数之间的相关性分析计算Pearson相关系数。结果患者中90例有肝炎病史,包括83例乙肝,5例丙肝,1例并发乙肝和丁肝,1例自身免疫性肝炎。病理分化程度:高、中、低分化分别为28、36、22例,2例分化程度不清楚,4例患肝未发现肿瘤。腔静脉、门静脉及胆道残端及切缘阴性90例,阳性2例。卫星灶阴性64例,阳性28例。微血管侵犯阴性51例,阳性41例。检出门脉及间质脉管瘤栓阴性患者60例,阳性32例。肝本底及纵隔血管本底SUVmax(LBmax,Mmax)的相关性为0.867,肝组织本底高于纵隔本底。肿瘤代谢参数SUVmax及SUL的相关性为0.985;瘤本比(TLR及TMR)的相关性为0.986。不同TNM分期的代谢参数组间没有差异。病理类型肝细胞肝癌组及胆管细胞癌组、中分化与低分化的病变代谢参数无显著差异。肿瘤数量、肿瘤部位、是否有肝硬化、肝炎类型及是否活动、是否有癌栓、甲胎蛋白水平、静脉及胆道切缘是否阴性、是否有门脉及间质脉管瘤栓等与代谢参数无显著差异。淋巴结转移组与非转移组的SUVmax、TMR、TLR、SUL、MTV、TLG有显著差异Objective To explore the value of 18F-FDG PET/CT in preoperative evaluation by analyzing the clinical characteristics and PET/CT metabolic parameters of liver transplantation patients with liver cancer.Methods A retrospective study from October 2014 to May 2017 was carried out,a total number of 92 patients with liver cancer who received liver transplantation and had PET/CT examination pre and post operation in Tianjin First Central Hospital were enrolled.Metabolic parameters were measured or calculated using TrueD software including the maximum standardized uptake value(SUVmax)of normal liver parenchyma,liver cancer lesions and mediastinum,SUV normalized to lean body mass(SUL),tumor metabolic volume(MTV),tumor-to-mediastinum SUV ratio(TMR),tumor-tonormal liver SUV ratio(TLR)and total lesion glycolysis(TLG).The correlation between metabolic parameters and clinical characteristics and their value in predicting pathological indicators were analyzed by one-way analysis of variance(ANOVA),and the correlation between metabolic parameters was analyzed to calculate the Pearson correlation coefficient.Results A total number of 90 patients had a history of hepatitis,including 83 cases of hepatitis B,5 cases of hepatitis C,1 case of hepatitis B and D,and 1 case of autoimmune hepatitis.The high,medium and low pathological differentiation cases were 28,36 and 22,respectively.Two cases with unclear differentiation and 4 cases had no tumor.There were 90 cases of negative stump or incisal edge of vena cava,portal vein and biliary system,and 2 cases were positive.A total number of 64 cases were negative for satellite nodules and 28 cases were positive.51 cases were negative of microvascular invasion(MVI)and 41 cases were positive.A total number of 60 patients were negative of detected portal vein and interstitial vascular tumor embolus and 32 cases were positive.The correlation coefficient between the SUVmax of liver background and mediastinum background(LBmax,Mmax)was 0.867,and LBmax was higher than Mmax.The correlation coeffici

关 键 词：肝移植 肝癌 PET/CT 代谢参数 

分 类 号：R735.7[医药卫生—肿瘤]