^(18)F-FDG PET/CT与增强CT对肝癌栓塞治疗后的疗效评估

Value of ^(18)F-FDG PET /CT and contrast-enhanced CT in the evaluation of efficacy evaluation of hepatocellular carcinoma patients after transcatheter arterial chemoembolization

目的探讨18F-FDG PET/CT与增强CT对肝癌栓塞治疗后的疗效评估价值。方法回顾性分析2009年9月～2012年3月期间在我院接受动脉导管栓塞化疗(TACE)并接受PET/CT检查的28例原发肝细胞癌患者的临床及影像学资料;将肝动脉栓塞治疗后4～5 w的PET/CT检查结果,增强CT结果与AFP值对照分析,判断病灶内是否有肿瘤残留或复发。结果本组28例中24例与AFP进行对照,其中11例治疗后AFP降低到正常水平,5例18F-FDG PET/CT与增强CT显示肿瘤区域见不同程度的碘油聚集,未见异常强化影和FDG浓聚影;6例CT可见异常强化影,未见异常FDG聚集,考虑强化影可能为再生结节或炎性肉芽组织。治疗后AFP未降到正常水平13例,其中7例见不同程度碘油聚集,CT增强见结节及斑片强化影,FDG异常聚集;6例FDG异常聚集,CT未见异常强化。3例患者治疗前、后AFP均正常,TACE治疗后4 w行增强CT扫描见碘油聚集边缘有结节样强化,CTA可见异常血管影,18F-FDG PET/CT可见斑片状摄取增高影,经穿刺活检证实为肿瘤复发。1例肝右后上叶巨块型肝癌,治疗前后AFP均正常,CEA升高,18F-FDG PET/CT检查在碘油聚集的边缘可见异常FDG摄取,CT增强未见异常强化,经穿刺活检证实为肿瘤复发。结论18F-FDG PET/CT显像结果与AFP对照其在判断肝细胞癌动脉栓塞治疗后复发和转移上明显高于CT增强扫描。

Objective To assess the clinical value of 18F-FDGPET/CT and contrast-enhanced CT （CECT） in evaluation of the efficacy evaluation of hepatocellular carcinoma patients after transcatheter ar- terial chemoembolization. Methods The findings of 18 F-FDG PET/CT and CECT and the level of AI- pha-fetoprotein（AFP） of 24 hepatocellular carcinoma patients after TACE were retrospectively analyzed. The results of 18F-FDG PET/ CT and CECT, the level of AFP before and after TACE were anlaysized. Results In 28 patients, 24 patients had elevated AFP level, the AFP level was decreased to normal af- ter treatment in 11 patients, had no FDG avid lesions and comfirmed no recurrence lesions or new metas- tases. In these 11 patients, the contrast-enhanced CT showed enhanced lesions around the dense lipiodol retention in 6 patients, but 18F-FDG PET/ CT did not show abnormal FDG accumulation, were regarded as granuloma. In the 13 patients who had FDG active lesions with elevated AFP after TACE, recurrence lesions were confirmed by surgery and biopsy, only 7 had enhanced CT scan, and the 4 patients who had FDG avid lesions with normal AFP before and after treatment confirmed recurrence by biopsy, only 3 had enhanced lesions. One case showed normal AFP level before and after treatment, had increased CEA and abnormal FDG accumulation by 18F-FDG PET/CT and no abnormal enhanced lesion was revealed by CT examination, had cancer recurrence confirmed by biopsy. Conclusion 18 F-FDG PET/ CT is a more valuable imaging tool than CECT in detection of recurrence lesions or new metastases in HCC patients with elevated AFP level after TACE.