PET／CT对TACE联合RFA治疗原发性肝癌的疗效评价

Efficacy evaluation of transcatheter arterial chemo-embolization combined with radiofrequency ablation on patients with hepatocellular carcinoma by PET/CT

目的探讨PET／CT在经动脉导管栓塞化疗（TACE）联合射频消融（RFA）治疗原发性肝癌后的应用价值。方法本组21例原发性肝癌患者共有31个病变，肿瘤最大径为1．0—12．5cm。其中15例为初治病例，6例为肝癌手术后复发。经过TACE联合RFA治疗后3周，对比CT和PET／CT检查的结果。如发现有肿瘤残留，在1周内对其再次行RFA治疗。结果21例患者经一次TACE联合一次RFA治疗3周，经病变区域活检及数字减影血管造影等检查发现19例有部分肿瘤残留，肿瘤残留最大径为0．5—3．5cm。CT增强扫描检查检出10例，检出率为52．6％；PET／CT检出有17例残留，检出率为89．5％。根据PET／CT检查结果，在1周内再次行RFA治疗，PET／CT检查发现16例患者肿瘤无残留，1例患者3周后复查PET／CT发现肝内病变未完全控制，行第3次RFA。结论原发性肝癌经TACE联合RFA治疗后，PET／CT对判断肿瘤残留以及指导进一步RFA治疗较CT检查具有更大的优势。

Objective To investigate the value of PET/CT in judging tumor residue of hepato- cellular carcinoma （ HCC ） after treated by transcatheter arterial chemo-embolization （ TACE ） combined with radiofreq uency ablation （RFA）. Methods Twenty one HCC patients with 31 lesions, 1.0 - 12.5 cm in diameter, were treated in our hospital from December 2009 to December 2011. Of the 21 patients, 15 cases were naive patients with 21 lesions, 6 patients were relapsed after hepatectomy. The results of CT and PET/CT of the 21 patients 3 weeks after treatment of TACE combined with RFA were compared. If tumor residue was dictated, a further RFA treatment would be applied within one week. Results Of the 21 HCC patients that received one course of TACE combined with RFA, 19 cases had tumor residues which were conformed by fine needle biopsy and digital substraction angiography（DSA）. CT only detec- ted 10 positive cases; however, PET/CT detected 17 positive cases. Positive rate of CT was 52. 6% , and that of PET/CT was 89.5%. According to the results of PET/CT of the 17 patients, after the second course of RFA, 16 patients had no tumor residue, 1 case survived with uncontrolled lesions 3 weeks after treatment. Conclusions PET/CT is better than CT in judging tumor residue of HCC after treatment of TACE combined with RFA, and in guiding further treatment of HCC.