18F-FDG PET/CT在肝癌肝移植术后复发监测中的临床应用价值

目的评价18F-脱氧葡萄糖正电子发射体层摄影术(FDG PET)/CT在肝癌肝移植术后复发监测中的临床应用价值。方法选择41例肝癌肝移植术后患者行18F-FDG PET/CT显像,分析比较PET、PET/CT和甲胎蛋白(AFP)对复发、转移病灶的检测效能,并分析病灶18F-FDG摄取高低和PET检测阳性率与肿瘤分化、个体荷瘤数量及AFP水平的关系。结果 41例肝癌肝移植术后患者中经临床证实肿瘤复发转移者38例,18F-FDG PET/CT诊断肿瘤复发转移的灵敏度、特异性分别为94.7%、66.7%。肝内复发者17例,PET和PET/CT的阳性检出率分别为58.8%和82.4%。肝外转移者36例,最常见部位为淋巴结(23例),其次为肺(17例)和骨(11例)。PET对肺转移灶及腹膜转移灶的检出率为70.6%、0.0%,而PET/CT均为100%;PET和PET/CT对其他部位肝外转移灶的阳性检出率相同(均为100%)。AFP检测对肝细胞癌(HCC)移植术后复发的诊断灵敏度为73.0%,低于18F-FDG PET/CT(94.6%),二者比较差异有统计学意义(χ2=6.366,P<0.05)。PET对单发病灶复发的阳性检出率低于多发病灶者(P<0.05),而PET的阳性检出率与HCC的分化及AFP水平的高低无明显相关(P>0.05)。病灶最大标准摄取值(SUVmax)与个体荷瘤数量密切相关(P<0.05),但与肿瘤的分化及AFP水平无关(P>0.05)。结论 18F-FDG PET/CT能灵敏地检测肝癌肝移植术后肿瘤复发及转移病灶,具有较好的临床应用价值。

Clinical value of 18F-FDG PET/CT on detection of recurrence in HCC patients with liver carcinoma after transplantation

Objective To assess the value of 18F-fluorodeoxyglucose(FDG) PET/CT on the detection of the posttransplant recurrence in the patients with liver carcinoma.Methods18F-FDG whole-body PET/CT scan was performed in 41 patients with liver carcinoma after liver transplantation.The potency of 18F-FDG PET,PET/CT and alpha fetoprotein(AFP)on the detection of recurrent tumors was investigated and compared.In addition,the correlations of FDG uptake and positive detection of PET with the histologic grade,tumor-bearing amounts and AFP levels were analyzed.ResultsOf 41 patients,38 were diagnosed with recurrent and/or metastatic tumors.The sensitivity and specificity of 18F-FDG PET/CT in diagnosing recurrent and/or metastatic tumors were 94.7% and 66.7%.17 patients had intrahepatic recurrence.The positive detection of PET and PET/CT for intrahepatic recurrence were 58.8%,82.4%,respectively.In 36 patients with extrahepatic metastasis,the most common extrahepatic sites were the lymph nodes,lungs and bone.The positive detections of PET for the lungs and the peritoneum metastasis were 70.6% and 0.0%,respectively.However,those of PET/CT were 100%.100% of positive detections of both PET and PET/CT for other extrahepatic sites were demonstrated.The sensitivity of AFP in predicting recurrence of hepatocellular carcinoma(HCC)was significantly lower than that of 18F-FDG PET/CT(73.0% vs.94.6%,χ2=6.366,P<0.05).The positive detection of 18F-FDG PET in the patients with solitary recurrent lesion was significantly lower than that of patients with multiple tumors(χ2=8.223,P<0.05),while it was not correlated with histologic grade and AFP levels(P>0.05 for the both).SUVmax was correlated with tumor-bearing amounts(P<0.05),while it was not correlated with histologic grade and AFP levels(P>0.05).Conclusion18F-FDG PET/CT appears to be a good modality on the detection of the intrahepatic for the both recurrence and extrahepatic metastasis in the patients with liver carcinoma after transplantation.