11C-胆碱显像在18F—FDG显像诊断不明确肝占位病变患者中的应用

目的研究11C-胆碱PET／CT显像在18F-脱氧葡萄糖（FDG）PET／CT显像诊断不明确的肝占位病变中的应用价值。方法对18F—FDGPET／CT诊断不明确的20例患者共25个肝占位病变，行肝局部11C-胆碱PET／CT显像。病灶处出现11C-胆碱局限性摄取增高者考虑为阳性。将最大标准摄取值（SUVmax）和靶／肝放射性（T／L）比值作为半定量分析指标。采用SPSS11．5软件，行Mann-Whitney和Kruskal—Wallis秩和检验及，检验。结果25个肝占位性病变中，21个为肝细胞癌，3个为血管瘤，1个为霉菌性肉芽肿。11c-胆碱显像对肝细胞癌灶的阳性检测率为66．7％（14／21）。11c-胆碱显像对高分化肝细胞癌的阳性检测率高于对中、低分化肝细胞癌（8／9和2／5）。肝癌阳性组、阴性组和良性病变组的T／L比值差异有统计学意义（1．70±0．35，0．86±0．15和0．36±0．18，X^2=19．00，P〈0．01）。肝癌阳性组和阴性组间的病灶大小和甲胎蛋白（AFP）水平差异无统计学意义（Mann—Whitney U=39．00，P〉0．05和U=16．00，P〉0．05）。结论11C-胆碱PET／CT能在较大程度上弥补18F—FDGPET／CT对肝细胞癌检测的不足，其更适合检测高分化肝细胞癌。

Application of 11C-choline PET/CT for the hepatic space-occupying lesions with an indeterminate diagnosis by 18F-FDG PET/CT

Objective To explore the value of 11C-choline PET/CT in patients with hepatic spaceoccupying lesions that have an indeterminate diagnosis by 18F-fluorodeoxyglucose (FDG) PET/CT. Methods A total of 25 liver masses in 20 patients with an indeterminate diagnosis based on 18F-FDG PET/CT were enrolled. Regional 11C-choline PET/CT scan was performed in all of the patients. Lesions with intense 11C-choline uptake were considered as positive. The semiquantitative maximum standardized uptake value(SUVmax) was measured and the tumor-to-liver (T/L) radioactivity ratio was calculated. The Mann-Whitney test,Kruskal-Wallis test and crosstabs x2-test were performed by using SPSS version 11.5. Results Of the 25 lesions,21 were proven to be hepatocellular carcinomas (HCC),3 hemangiomas,and 1 parasitic granuloma. The sensitivity of 11C-choline PET/CT for the detection of HCC was 66.7% (14/21). 11C-choline PET/CT had a higher sensitivity for well differentiated HCC than moderately and poorly differentiated HCC on a patient basis (8/9 vs 2/5,respectively). There were significant differences of 11C-choline T/L ratios between the HCC positive group,HCC negative group and benign lesion group ( 1.70 ± 0.35,0.86 ± 0.15,and 0.36 ± 0.18,x2 = 19.00,P ＜0.01 ). The lesion size and alphafetoprotein (AFP) level between the HCC positive and negative groups had no significant difference respectively ( Mann Whitney U = 39.00,P ＞0.05,and U=16.00,P＞0.05,respectively). Conclusions 11C-choline is complementary to 18F-FDG PET/CT for the detection of HCC,especially for well differentiated HCC.