^(18)F-FDG PET/CT延迟显像在原发性肝癌诊断中的应用价值

Application value of ^(18)F-FDG PET/CT delayed imaging in diagnosis of primary liver cancer

目的探讨^(18)F-氟脱氧葡萄糖(^(18)F-FDG)的正电子发射计算机断层显像(PET)/CT延迟显像在原发性肝癌(肝癌)中的诊断价值。方法回顾性分析2014年10月至2016年12月在中山大学附属第三医院接受诊治的80例肝癌患者临床资料。其中男62例,女18例;平均年龄(58±12)岁。根据肿瘤直径大小分为小肝癌组(30例)、结节肝癌组(23例)和大肝癌组(27例)。患者均签署知情同意书,符合医学伦理学规定。患者静脉注射^(18)F-FDG造影剂40~60 min后行早期PET/CT显像,2 h后行延迟PET/CT显像,测定两次显像中病灶最大标准摄取值(SUV_(max))。观察并比较小肝癌组、结节型肝癌组、大肝癌组的早期和延迟显像情况及不同时期显像变化。3组SUV_(max)比较采用单因素方差分析和LSD-t检验,两组比较采用t检验,率的比较采用χ~2检验。结果结节型肝癌组的早期像、延迟像SUV_(max)分别为5.1±1.9、5.5±2.3,明显高于小肝癌组的3.9±1.4、4.3±2.0(LSD-t=2.60,2.03;P<0.05);而低于大肝癌组的6.9±2.6、8.5±2.9(LSD-t=-2.82,-4.08;P<0.05)。大肝癌组延迟像SUV_(max)明显高于早期像组(t=2.05,P<0.05)。大肝癌组延迟像SUV_(max)较早期像明显升高患者百分率为93%(25/27),明显高于小肝癌组、结节型肝癌组的53%(16/30)、61%(14/23)(χ~2=10.85,7.28;P<0.05)。结论随肿瘤直径增加,延迟像^(18)F-FDG摄取明显增加,采用^(18)F-FDG PET/CT延迟显像技术可提高肝癌尤其大肝癌的检出率。

Objective To investigate the diagnostic value of tSF-fluorodeoxyglucose （tSF-FDG） positron emission tomography （PET）/CT delayed imaging in the diagnosis of primary liver cancer. Methods Clinical data of 80 patients with primary liver cancer who were admitted to the Third Affiliated Hospital of Sun Yat-sen University between October 2014 and December 2016 were retrospectively analyzed. Among them, 62 cases were males and 18 were females, aged （58±12） years old on average. According to the tumor diameter, the patients were divided into the small liver cancer group （n=30）, nodular liver cancer group （n=23） and large liver cancer group （n=27）. The informed consents of all patients were obtained and the local ethical committee approval was received. PET/CT early imaging was performed on the patients at 40-60 rain after they were intravenously injected with contrast agent 18F-FDG, and PET/CT delayed imaging was performed at 2 h later. The maximal standardized uptake values （SUVmax） of the lesions in two imagings were detected. The early imaging, delayed imaging and the imaging changes at different stages were observed and compared among three groups. The SUVmax values were compared among three groups using one-way analysis of variance and LSD-t test, and were compared between two groups using t test. The rates were compared using Chi-square test. Results The SUVmax values of the early imaging and delayed imaging were respectively 5.1±1.9 and 5.5±2.3 in the nodular liver cancer group, significantly higher than 3.9±1.4 and 4.3±2.0 in the small liver cancer group （LSD-t=2.60, 2.03; P〈0.05）, whereas significantly lower than 6.9±2.6 and 8.5±2.9 in the large liver cancer group （LSD-t=-2.82, -4.08; P〈0.05）. The SUVmax value of the delayed imaging in the large liver cancer group was significantly higher than that of the early imaging （t=2.05, P〈0.05）. The percentage of patients with SUVmax values of the delayed imaging higher than that of the early imaging was 93%（25/27） in the large liver cancer group, significantly higher than 53%（16/30） in the small liver cancer group and 61%（14/23） in the nodular liver cancer group （Z=10.85, 7.28; P〈0.05）. Conclusions The 18F-FDG uptake of the delayed imaging increases significantly along with the tumor diameter increases. Application of 18F-FDG PET/CT delayed imaging can elevate the detection rate of liver cancer, especially large liver cancer.