^18F-FDG PET／CT在肝癌治疗后AFP升高患者中的应用

The application of ^18F-FDG PET/CT in patients with rising serum AFP elevation after management of hepatoceliular carcinoma

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT检测肝癌治疗后甲胎蛋白（AFP）升高患者肿瘤复发和（或）转移病灶的价值。方法原发性肝细胞癌治疗后血清AFP升高患者123例，皆行全身^18F-FDG PET／CT显像。所有图像经图像融合后，进行PET／CT融合图像、PET图像和CT图像帧对帧对比分析。肿瘤复发和（或）转移病灶根据病理检查结果、多种影像学诊断及临床随访而确诊。随访时间均〉6个月。采用SPSS 11．5软件进行统计学处理，进行，检验。结果123例患者中，明确诊断肿瘤复发和（或）转移者111例^18F-FDG PET显像诊断肿瘤复发和（或）转移78例，其灵敏度为70．3％（78／111）；^18F-FDG PET／CT显像诊断肿瘤复发和（或）转移97例，灵敏度提高至87．4％（97／111，χ^2=9．744，P=0．002）。^18F—FDG PET／CT诊断肝癌复发和转移的特异性、准确性、阳性预测值和阴性预测值分别为83．3％（10／12）、87．0％（107／123）、98．0％（97／99）和41．7％（10／24）。9例高分化肝细胞癌患者均确诊为肿瘤复发和（或）转移，^18F-FDG PET／CT显像诊断其肿瘤复发和（或）转移5例，灵敏度（5／9）明显低于总体灵敏度（87．4％；χ^2=6．616，P=0．01）。结论^18F—FDG PET／CT显像在检测原发性肝癌治疗后AFP升高患者肿瘤复发和（或）转移病灶中有较好的应用价值，但高分化肝细胞癌可能出现假阴性。

Objective The aim of this study was to evaluate the clinical role of ^18 F-fluorodeoxyglueose （FDG） PET/CT for detection of recurrent and （or） metastatic tumor in patients with rising serum alpha fetoprotein （AFP） after the management of hepatocellular carcinoma （HCC）. Methods The whole body ^18F-FDG PET/CT scans were performed in 123 patients with rising serum AFP [ （3554. 49 ± 1663.08） μg/L; normal level： 0-8.1 μg/L] on routine follow-up examinations after the management of HCC. All PET and CT images of one patient were fused by the specific software on workstation. PET images, CT images and PET/CT fused images were analyzed by frame to frame. All patients were followed up for more than six months. The final diagnosis was obtained by pathologic finding from surgery or biopsy, and （or）muhi-modalities of imaging and clinical follow-up. Chi-Square test for statistics was used with SSPS 11.5 software. Results There were 111 patients proved to be suffered with recurrent and （or） metastatic tumor. Intrahepatic lesions were found in 84 patients; extrahepatic lesions were found in 65 patients. The overall sensitivity of ^18F-FDG PET/CT for tumor detection was 87.4% （97/111 ） and it was obviously higher than 70.3% （78/111） of ^18F-FDG PET alone（χ^2 = 9. 744, P = 0.002）. The specificity, accuracy, positive predictive value and negative predictive value of ^18F-FDG PET/CT was 83.3% （ 10/12 ）, 87.0% （ 107/123 ）, 98.0% （97/99） and 41.7% （10/24） , respectively. The PET and CT were complement in the lesions detection. In 9 patients proved as well-differentiated HCC, the sensitivity of 18 F-FDG PET/CT was 5/9, which was lower than that of overall sensitivity （χ^2 = 6. 616, P = 0.01 ）. Conclusions ^18 F-FDG PET/CT is a valuable imaging tool to detect the recurrent and （or） metastatic tumor in patients with rising serum AFP after HCC treatment. Nevertheless, a pitfall of false-negative could be happened in patients with well-differentiated HCC.