^(18)F-脱氧葡萄糖PET/CT显像在肝细胞癌经导管肝动脉化疗栓塞术后残留病灶诊断和预后判断中的价值

Value of ^(18)F-fluorodeoxyglucose PET/CT in detecting viable tumor and predicting prognosis of hepatocellular carcinoma after transcatheter arterial chemoembolization treatment

目的探讨18F-脱氧葡萄糖(FDG)PET/CT显像在肝细胞癌(HCC)经导管肝动脉化疗栓塞术(TACE)后残留病灶的诊断和预后判断中的价值。方法回顾性分析73例HCC患者TACE后行18F-FDG PET/CT检查,以临床随访及病理结果为标准进行对照分析。根据TACE术后碘油在肝癌病灶中沉积面积的大小分为3型。Ⅰ型:碘油沉积面积>60%的病灶面积;Ⅱ型:碘油沉积面积占病灶面积的20%~60%;Ⅲ型:碘油沉积面积<20%的病灶面积。18F-FDG PET/CT诊断残留病灶的效能与增强CT(CECT)进行对比分析,并进一步探讨肿瘤最大标准摄取值与正常肝组织平均标准摄取值的比值(TSUVmax/LSUVmean)与生存预后的关系。结果比较受试者工作特征曲线(ROC)曲线下面积显示,18F-FDG PET/CT显像在HCC患者TACE术后残留病灶检测中的价值显著优于CECT(P=0.04)。TSUVmax/LSUVmean≥1.65与肿瘤大小(P=0.009 6)、碘油沉积面积(P=0.038 7)、血清甲胎蛋白(AFP)水平(P=0.014 2)显著相关,但与肿瘤病理分级无明显相关性(P=0.262 6)。TSUVmax/LSUVmean<1.65组患者的总生存率显著增高(P=0.024)。结论 18F-FDG PET/CT显像在HCC患者TACE术后残留活性病灶的检测中有较高的诊断效能,且真实性和可靠性良好,明显优于增强CT;同时TSUVmax/LSUVmean可作为TACE治疗后患者生存预后的独立预测因子,对协助临床确定个体化治疗方案具有重要价值。

Objective To evaluate the efficacy of 18F-fluorodeoxyglucose（18F-FDG） PET/CT in detecting viable tumor and predicting prognosis of hepatocellular carcinoma （HCC） after transcatheter arterial chemoembolization （TACE） treatment. Methods A total of 73 patients with 91 HCCs who had undergone TACE with lipiodol before 18F-FDG PET/CT were retrospectively analyzed. The pattern of lipiodol deposition in the tumor was divided into three grades： Grade I, the area of lipiodol remaining over 60% of the tumor; Grade Ⅱ, 20%-60%; Grade Ⅲ, less than 20%. The performance of 18F-FDG PET/CT in evaluating the viability of HCC was assessed and compared with that of contrast-enhanced CT （CECT）. The predictive value of maximal tumor standardized uptake value （SUV） to mean liver SUV （TSUVmax/LSUVmean） ratio was tested. Results By comparing the area under the receiver operating characteristic curve 18F-FDG-PET/CT was found to be superior to CECT for the detection of viable tumor in patients with HCC after TACE （P=0.04）. A high SUV ratio （TSUVmax/LSUVmean≥1.65） was correlated significantly with tumor size （P=0.009 6）, grade of lipiodol deposition （P=0.038 7） and serum α-fetoprotein（AFP） level （P=0.014 2）, but not correlated with pathologic grade （P=0.262 6）. Overall survival rate was significantly higher in low SUV ratio （TSUVmax/LSUVmean〈1.65） group （P=0.024）. Conclusion 18F-FDG-PET/CT is efficient in assessing the viability of HCC after TACE treatment and superior to CECT. It can provide valuable information for prediction of prognosis and treatment strategy.