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PET/CT显像在肝细 胞癌患者术后随访 中的价值

作者:谢 勇 刘吉奎 刘 旭 刘晓平 田佩凯 黄志峰

所属单位:北京大学深圳医院肝胆胰外科 (广东 深圳 518035)

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摘要

目的 探讨1 8 F氟代脱氧葡萄 糖(18F-FDG)PET/CT显像在肝细胞癌 (HCC)患者术后随访中的应用价值。方 法 回顾性分析2011年4月-2016年4月医院 PET中心检查的86例疑似HCC术后复发、转 移患者的18F-FDG PET/CT显像结果,评价 18F-FDG PET/CT对肝癌术后复发、转移的 诊断效能。结果 全组病例随访13-59个 月,经组织病理或临床随访证实52例复发 和(或)转移,其中单独肝内复发者27 例,单独肝外转移者6例,肝内复发合并 肝外转移者19例。以组织病理或临床随访 为“金标准”,18F-FDG PET/CT诊断HCC术 后复发或(和)转移的敏感性为94.23%, 特异性为88.24%,准确性为91.86%。结 论 18F-FDG PET/CT显像对HCC术后复发、 转移的检出率较高,便于全面评估患者病 情。

Objective To investigate the value of 18F fluorodeoxyglucose (18F-FDG) PET/CT imaging in postoperative follow-up of patients with hepatocellular carcinoma (HCC). Methods The 18F-FDG PET/CT imaging results of 86 patients with suspected recurrence and metastasis of HCC after operation who were examined in PET Center of the hospital during April 2011 to April 2016 were analyzed retrospectively. The diagnostic efficiency of 18F-FDG PET/CT for recurrence and metastasis of HCC after operation was evaluated. Results All cases were followed up for 13-59 months. 52 cases of recurrence and/or metastases were confirmed by histopathology or clinical follow-up. Among them, there were 27 cases with solitary intrahepatic recurrence, 6 cases with solitary extrahepatic metastasis, and 19 cases with intrahepatic recurrence and extrahepatic metastasis. With histopathology or clinical follow-up as the golden standard, the sensitivity, specificity and accuracy of 18F-FDG PET/CT in the diagnosis of recurrence or (and ) metastasis of HCC after operation were 94.23%, 88.24% and 91.86%, respectively. Conclusion The detection rate of recurrence and metastasis of HCC by 18F-FDG PET/CT imaging after operation is high, which is good for comprehensive evaluation of patient's condition.

【关键词】氟代脱氧葡萄糖;PET/CT;肝 细胞癌;术后随访

【中图分类号】R322.4+7

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.09.027

前言

肝癌是临床常见恶性肿瘤之一,位于全球高发恶性肿瘤的第5位, 2015年肿瘤节权威杂志《CA:Cancer Journal for Clinjicians》中的 报告估测肝癌位居2015年中国癌症死因的第3位[1]。肝细胞癌(HCC)占 所有原发性肝癌的90%以上,手术切除或射频消融术(RFA)治疗HCC有效 手段,但5年复发率仍高达70%左右。国内研究指出,术后复发、转移 是影响HCC患者预后生存质量的重要因素[2]。因此早期诊断HCC术后复 发转移,早期给予干预治疗尤为重要。以往临床常采用B超、超声造 影、CT、MRI等进行恶性肿瘤术后随诊,但在监测术后转移、复发中均 有各自的局限性。18F-FDG PET/CT结合了PET的功能代谢影像及CT的解 剖形态影像,可反映肿瘤葡萄糖代谢异常情况及全身情况,在肿瘤术 前诊断、临床分期、术后随访中有重要价值。本研究对近5年的疑似 HCC术后复发、转移患者的病例资料及随访资料进行回顾性分析,探讨 18F-FDG PET/CT在监测HCC术后患者复发、转移中的应用价值,现报告 如下。