18F-FDG PET/CT在肝癌患者接受肝脏器官移植术前、后的临床应用价值

目的 评价^18F-FDG PET—CT在肝癌患者肝移植术前评估和在术后早期发现小复发病灶中的价值。方法 回顾性分析19例肝癌患者拟行或已行肝移植手术患者的临床和^18F—FDG PET—CT影像学资料。肝移植术前进行^18FDG PET-CT扫描8例10次，肝移植术后进行^18F-FDG PET—CT扫描者22次（11例患者）。结果 8例肝移植术前评估的患者中有2例PET显像全身各部位均未发现转移性病灶．均按期接受了肝移植手术；有2例PET显示转移灶位于拟手术野区域内，故也按期进行了移植手术（术中对局部的转移灶做了外科清扫）；有4例患者因已有不同程度的远处转移，与家属讲明原因后放弃肝移植手术，而改用介入或其他内科治疗。肝移植术后进行扫描者22次（11例患者），其中2例患者术后行PET检查未发现肿瘤复发及全身其他部位的转移灶：1例患者术后发现霉菌性脑脓肿：在其余19次（8例患者）PET检查中发现移植的肝内出现复发病灶者4例．另外还发现肝左右静脉和下腔静脉内癌栓、肺内、多部位多发淋巴结、骨、脾脏内、胸壁胸膜、胸椎椎间孔等处转移征象。结论 ^18F—FDG PET—CT全身性扫描兼有对肿瘤显示高度敏感性的两个优势，在肝移植术前评估和术后早期发现复发病灶的临床应用中均起着重要和不可替代的作用。

Clinical value of pre-and postoperative 18F-FDG PET/CT in patients undergoing liver transplantation for hepatocellular carcinoma

Objective To assess the clinical value of fluorine-18-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT) in preoperative evaluation of hepatocellar carcinoma (HCC) patients for liver transplantation and in early detection of recurrent foci after the operation. Methods A retrospective study was conducted involving 19 HCC patients undergoing 18F-FDG PET/CT before and after liver transplantation. The pre- and postoperative clinical data and 18F-FDG PET/CT images of these patients were analyzed. Totally 10 18F-FDG PET/CT examinations (in 8 patients) were performed for purpose of preoperative evaluation of the transplantation and assessment of the tumor elimination and general metastasis following the adjuvant therapy, and 22 examinations (in 11patients) performed postoperatively to identify recurrent foci and metastasis. The average time span between 18F-FDG PET/CT examination and the operations was 8.68 months. Results PET examinations in 2 patients for preoperative evaluations showed no evidence of tumor recurrence or metastasis, so they underwent liver transplantation as scheduled. 18F-FDG PET/CT found distinct metastasis in the target operation area in another 2 patients, and liver transplantation was performed with proper management of the metastatic foci. The other 4 patients were found to have distal metastasis, so that operations were cancelled and the patients received interventional therapy and other treatments instead. Postoperative 18F-FDG PET/CT examination discovered no metastatic foci in 2 patients, but detected mycotic brain abscess in 1 patient. Another 19 postoperative 18F-FDG PET/CT examinations (in 8 patients) showed recurrence in the grafted liver (in 4 patients), tumor embolism in the left and right hepatic veins and in the inferior vena cava, in addition to metastasis to the lungs, lymph nodes, bone, spleen, parietal pleura, intervertebral foramen of the thoracic vertebra etc. Conclusion 18F-FDG PET/CT scanning shows superior accuracy in identification of lymph node tumor metastasis. With the advantages of whole-body scanning and high sensitivity of tumor detection, 18F-FDG PET/CT can be instrumental in preoperative evaluation of liver transplantation for HCC (such as modification of the clinical staging) and postoperative early detection of recurrent tumors.