正电子发射计算机体层成像-CT在监测甲胎蛋白阳性肝癌介入治疗后残留病灶和肝外转移病灶中的作用

Application of PET-CT in monitoring residual and extrahepatic metastatic lesions for hepatocellular carcinoma with positive alpha fetoproteins after interventionai therapy

目的探讨PET-CT在甲胎蛋白（AFP）阳性肝细胞癌介入术后监测碘油沉积区内残留病灶及肝外转移病灶的价值。方法选取20例经病理组织学确诊的原发性肝细胞癌患者，在介入治疗后AFP降至正常，随访发现AFP异常升高，常规行上腹部CT、MR检查未能明确碘油沉积区内残留病灶及肝外转移病灶或发现可疑影像学表现但不能确定其性质者行PET—CT扫描，依据PET-CT的结果进一步治疗，并用影像检查及AFP检查监测其治疗效果。结果20例患者中，常规上腹部影像检查未发现肝外转移病灶而经PET—CT检出者10例，包括邻近腹壁转移4例，肺内直径约1cm的孤立转移3例，肠系膜转移2例，手术切口转移1例；CT或MR／发现原碘油沉积区内有碘油沉积不均匀区域，但运用包括血管造影在内的检查方法均不能确定其是否为残留病灶而经PET—CT确诊者8例；CT扫描发现肝门区及腹膜后直径〈1．5cm的淋巴结但不能明确是否为淋巴结转移，经PET—CT明确者2例。采用外科手术及介入方法对检出病灶进一步治疗，除2例淋巴结转移患者AFP仍略高于正常外，其余患者AFP均逐渐降至正常，影像检查亦提示病灶治疗效果良好。结论PET-CT对于AFP水平异常升高而常规影像检查未能发现碘油沉积区残留病灶及肝外转移病灶或无法确定可疑影像表现性质的肝细胞癌患者是一种有效的检查方法。

Objective To investigate the value of positron emisson tomography-computed tomography（PET-CT） in monitoring the residual lesions in lipiodol sedimentary region and extrahepatic metastastic lesions of hepatocellular carcinoma （ HCC ） with alpha fetoproteins （ AFP ） positive after interventional therapy. Methods The data of 20 cases with primary HCC confirmed by histopathology were retrospectively analyzed. Their AFP levels decreased to normal range after interventional treatments, but rose to abnormal high level during following-up. After the abdominal routine imaging examinations, the definite diagnosis of the residual lesions in lipiodol sedimentary region or extrahepatic lesions can＇t be made confidently. All cases were scanned by PET-CT, and according to their PET-CT results, the further treatments were given and the therapeutic results were monitored with radiology and AFP tests. Results In all 20 cases, 10 of them were detected to have the extrahepatic metastastic lesions by PET-CT, including 4 with abdominal wall metastasis upon the liver, 3 with solitary pulmonary metastasis with diameter less than 1 cm, 2 with mesenteric mestastasis, 1 with mestastasis of operative incisions, but these lesions were neglected by abdominal routine imaging examinations. Eight cases showed the uneven lipiodol sedimentary region in the primary lesion by CT or MRI examination, but can＇t be diagnosed whether it was residual lesion with other examinations including DSA. A definite diagnosis was obtained by PET-CT. In 2 cases, lymph nodes less than 1.5 cm were found in the hepatic portal area （PHA） and retroperitoneum on CT images, which was determined to be metastatic by PET-CT. All the detected lesions were given further treatments of surgery or interventional therapy. Most patients showed decreased AFP levels except the 2 patients with lymph node metastasis. The imaging examinations also indicated that the treatments had a good effect on lesions. Conclusion In the patients with HCC and abnormal high levels of AFP, in addition to abdominal routine imaging examinations, PET-CT is beneficial for those who is suspected of residual lesions in lipiodol sedimentary region or extrabepatic metastasis.