^(18)F-FDG双时相及^(18)F-FDG联合^(11)C-CHO PET/CT多模态显像在原发性肝细胞肝癌中的诊断价值

Diagnostic value of 18F-FDG dual-phase and 18F-FDG combined with 11C-CHO PET/CT multimodality imaging in primary hepatocellular carcinoma

目的探讨^(18)F-氟脱氧葡萄糖(FDG)PET/CT双时相显像及^(18)F-FDG联合^(11)C-胆碱(CHO)PET/CT多模态显像对原发性肝细胞肝癌(HCC)的诊断价值。方法回顾性分析2016年3月至20^(18)年12月于内蒙古医科大学附属医院就诊的临床疑似原发肝占位性病变的73例患者的临床资料,其中男性41例、女性32例,年龄58~72岁;47例患者行^(18)F-FDG PET/CT双时相显像,26例患者行^(18)F-FDG联合^(11)C-CHO PET/CT多模态显像。分别测量并计算每个病变的最大标准化摄取值(SUV_(max))、肝本底SUV_(max)、肿瘤SUV_(max)/肝本底SUV_(max)比值(T/L)。以病变良恶性为状态变量,分别以^(18)F-FDG、^(18)F-FDG延迟、^(18)F-FDG双时相的SUV_(max)和^(18)F-FDG、^(11)C-CHO、^(18)F-FDG联合^(11)C-CHO的SUV_(max)为检验变量绘制受试者工作特征(ROC)曲线并进行两两比较,以组织病理学检查或临床随访结果为“金标准”,对比分析各种显像方法的诊断效能。计量资料的比较采用配对t检验;采用Z秩和检验比较各组间ROC曲线的差异。结果(1)^(18)F-FDG PET/CT双时相显像:47例患者共检出49个病变(其中32个为高代谢病变),经组织病理学检查或临床随访结果证实,40个为HCC(高分化8个、中低分化32个),9个为良性病变。中低分化HCC的病变SUV_(max)、肝本底SUV_(max)和T/L的差异均有统计学意义(t=4.51、-2.53、4.80,均P<0.05);高分化HCC的病变SUV_(max)和T/L的差异均有统计学意义(t=2.76、2.62,均P<0.05);良性病变SUV_(max)的差异无统计学意义(t=0.00,P>0.05)。^(18)F-FDG PET/CT显像分别与其延迟显像、双时相显像的SUV_(max)的ROC曲线间的差异均有统计学意义(Z=2.315、2.376,均P<0.05);而延迟显像与双时相显像的SUV_(max)的ROC曲线间的差异无统计学意义(Z=0.252,P>0.05)。(2)^(18)F-FDG联合^(11)C-CHO PET/CT显像:26例患者共检出26个病变(其中^(18)个为高代谢病变),经组织病理学检查或临床随访证实,22个为HCC(高分化9个、中低分化13个),4个为良性病变。高分化HCC的病变SUV_(max)、肝本底SUV_(max)间的差异均有统计学意义(t=9.49、6.57,均P<0.001),而T/L的差异无统计学意义(t=2.01,P>0.05);中低分化HCC的病变SUV_(max)的差异无统计学意义(t=-1.68,P>0.05),肝本底SUV_(max)、T/L间的差异均有统计学意义(t=8.41、-5.43,均P<0.001);良性病变的SUV_(max)的差异无统计学意义(t=1.51,P>0.05)。^(18)F-FDG与其联合^(11)C-CHO PET/CT的SUV_(max)的ROC曲线间的差异有统计学意义(Z=2.037,P<0.05)。结论^(18)F-FDG PET/CT双时相显像及^(18)F-FDG联合^(11)C-CHO PET/CT多模态显像可分别提高中低及高分化原发性HCC的检出率,对肝癌患者治疗方案的决策及临床预后判定有重要的指导价值。

Objective To investigate the diagnostic value of^(18)F-fluorodeoxyglucose(FDG)PET/CT dual-phase and^(18)F-FDG combined with^(11)C-choline(CHO)PET/CT multimodal imaging in primary hepatocellular carcinoma(HCC).Methods Retrospective PET/CT analysis was conducted on 73 patients(41 males,32 females;age range:58–72 years)in the Affiliated Hospital of Inner Mongolia Medical University from March 2016 to December 20^(18).The patients had not been confirmed with primary hepatic space-occupying lesions,47 patients underwent^(18)F-FDG PET/CT dual-phase imaging,and 26 patients underwent^(18)F-FDG combined with^(11)C-CHO PET/CT multimodal imaging.The _(max)imum standardized uptake value(SUV_(max))of each lesion,the liver background,and the tumor SUV_(max)/liver background SUV_(max)(T/L)value of each lesion were measured.Positive or negative lesions were adopted as state variables,and SUV_(max)(^(18)F-FDG,^(18)F-FDG delay,and^(18)F-FDG dual phase)and SUV_(max)(^(18)F-FDG,^(11)C-CHO,and^(18)F-FDG combined with^(11)C-CHO)were used as test variables.The receiver operator characteristic(ROC)curve was compared in pairs,and the histopathological examination or clinical follow-up results were used as the gold standard.The diagnostic efficacy of various imaging methods was compared and analyzed.The measurement data were compared through a paired t test,and the Z-rank test was used to compare the differences in the ROC curves of the groups.Results(1)^(18)F-FDG PET/CT dual-phase imaging:a total of 49 lesions were detected in 47 patients(32 of them were hypermetabolic lesions).Histopathological examination or clinical follow-ups confirmed that 9 lesions were benign and 40 were HCC(8 of them were well-differentiated and 32 were moderately-poorly differentiated).The SUV_(max) differences in the lesion,liver background,and T/L values of the moderately-poorly differentiated HCC were statistically significant(t=4.51,-2.53,4.80;all P<0.05).The SUV_(max) differences in the lesion and T/L values of well-differentiated HCC were statistically significant(t=2.76,2.62;both P<0.05),but no statistical difference was observed in the SUV_(max) value of the benign lesions(t=0.00,P>0.05).The ROC curve differences^(18)F-FDG SUV_(max) and delayed imaging,dual-phase imaging were statistically significant(Z=2.315,2.376;both P<0.05),however,the ROC curve differences of SUV_(max) between delayed imaging and dual-imaging wasn't statistically significant(Z=0.252,P>0.05).(2)^(18)F-FDG combined with^(11)C-CHO imaging:a total of 26 lesions were detected in 26 patients(^(18)of them were hypermetabolic lesions).Histopathological examination or clinical follow-ups confirmed that 22 lesions were HCC(of which 9 lesions were well-differentiated and 13 lesions were moderately-poorly differentiated),and 4 lesions were benign.The SUV_(max) differences in the lesion and liver background values of well-differentiated HCC were statistically significant(t=9.49,6.57;both P<0.05),but no statistically significant difference was observed in T/L value(t=2.01,P>0.05).The SUV_(max) difference in the lesion value of moderately-poorly differentiated HCC was not statistically significant(t=-1.68,P>0.05),but the SUV_(max) differences in liver background and T/L value were statistically significant(t=8.41,-5.43;both P<0.001).No statistical difference was also noted in the SUV_(max) of benign lesions(t=1.51,P>0.05).The difference in ROC curve between SUV_(max)(^(18)F-FDG)and SUV_(max)(^(18)F-FDG combined with^(11)C-CHO)was statistically significant(Z=2.037,P<0.05).Conclusion^(18)F-FDG PET/CT dual-phase imaging and^(18)F-FDG combined with^(11)C-CHO PET/CT multimodal imaging can improve the detection rate of moderately-poorly and well-differentiated primary HCC and have an important guiding value in decision-making and clinical prognosis for patients.