Specific diagnosis of hepatocellular carcinoma by delayed hepatobiliary imaging

For assessment of the value of delayed hepatobiliary imaging with technetium 99m (99mTc)-(Sn)-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) for specific diagnosis of hepatocellular carcinoma, 88 patients with various malignant and benign liver diseases (49 with hepatocellular carcinoma, 4 with cholangiocellular carcinoma, 10 with metastatic liver carcinoma, 2 with liver cysts, 2 with liver hemangioma, 1 with liver abscess, 2 with intrahepatic lithiasis, 12 with liver cirrhosis, and 6 with chronic hepatitis) were studied. In 20 (41%) of the 49 patients with hepatocellular carcinoma, greater uptake of 99mTc-PMT by the tumor than by the surrounding liver tissue was seen in delayed hepatobiliary images, whereas in eight patients (16%), equilibrated uptake was seen. No increased uptake of the radioisotope by hepatic lesions was seen in 21 patients with localized liver diseases other than hepatoma. Moreover, in 18 patients with diffuse liver diseases, no focal accumulation of the radioisotope was seen in delayed 99mTc-PMT images. In addition, of 28 patients with hepatocellular carcinoma in whom the serum alpha-fetoprotein level showed little or no increase, 12 showed increased uptake of 99mTc-PMT by the tumor. In assessing delayed 99mTc-PMT images, however, it was necessary to consider following complications: accumulation of tracer in obstructed and dilated biliary trees; retention of radioactivity in nonneoplastic liver tissues; difficulties in evaluating 99mTc-PMT uptake by small hepatic tumors; overlapping of radioactivity in the gut and gallbladder in delayed 99mTc-PMT images of tumors. This study indicates that delayed 99mTc-PMT images can be useful in the diagnosis of hepatocellular carcinoma.     

Delayed Tc-99m-PMT imaging in the specific diagnosis of hepatocellular carcinoma

The results of Tc-99m-PMT imaging on 100 patients with various malignant and benign hepatic diseases verified histologically (73 hepatocellular carcinoma, 3 liver cell adenoma, 1 cholangiocarcinoma, 5 metastatic liver carcinoma, 2 liver cyst, 12 hemangioma, 1 fatty degeneration, 1 liver regeneration, 1 postoperative liver fibrosis and 1 liver cirrhosis) are reported. All lesions appeared as decreased radioactivity or "cold" defect region on early Tc-99m-PMT imaging, rendering it valuable for the diagnosis of tumor localization. In 92 (95.8%) of the 96 patients with various hepatic tumors and 25 (86.2%) of the 29 patients with small hepatocellular carcinoma (less than 5 cm), the tumors were localized by early Tc-99m-PMT imaging. In 14 of the 73 patients with established hepatocellular carcinoma, the tumors gave greater radioactivity than that of the surrounding liver tissues, whereas in 31 patients the radioactivity of the tumor equalled the normal liver on delayed Tc-99m-PMT imaging (positive rate 61.6%). There was no significant difference between the positive rates of serum AFP level and the tumor size shown by delayed Tc-99m-PMT imaging in hepatocellular carcinomas. The radioactivity in 3 liver cell adenoma patients was similar to the gallbladder. No false positive result was seen in the other malignant and benign hepatic tumors. This study indicates that delayed Tc-99m-PMT imaging is highly specific in the diagnosis of hepatocellular carcinoma.     

The fucosylation index of alpha-fetoprotein and its usefulness in the early diagnosis of hepatocellular carcinoma

The serum concentration and degree of fucosylation (fucosylation index) of alpha-fetoprotein (AFP) were determined in serum samples from 258 patients with hepatocellular carcinoma (HCC) and 114 patients with benign liver diseases. When the serum AFP concentration was below 1000 ng/ml, it could not be used as a measure to distinguish between HCC and benign liver diseases. However, the fucosylation index of AFP proved useful for such a purpose. The sensitivity of the analysis using the fucosylation index in total patients with HCC was 69%; the specificity was 96% in benign liver diseases, and the accuracy of this test was 77%. When HCC patients who were grouped according to tumor size (5 cm, 3 cm, and 2 cm in diameter) were analyzed, they all had a fucosylation index significantly higher than that in benign liver disease patients. The mean fucosylation index in 28 patients with a serum AFP concentration below 1000 ng/ml and a tumor diameter less than 3 cm was 26 +/- 30%. Corresponding values for 16 patients with an AFP concentration below 400 ng/ml and a tumor size less than 3 cm and for 8 patients with a concentration below 400 ng/ml and a tumor size less than 2 cm were 32 +/- 31% and 27 +/- 27%, respectively. These values were higher, with statistical significance, than those in patients with benign liver diseases. These data indicate that the measurement of the fucosylation index of AFP is useful for the early diagnosis of HCC.     

微小肝癌和小肝癌诊断和治疗方式的共识和分歧

肝癌是常见的恶性肿瘤之一,其病死率高,预后差。微小肝癌和小肝癌的早期发现和早期治疗,能够有效提高肝癌患者的生存率。目前国内外针对微小肝癌和小肝癌的病因、临床表现、检查和治疗进行了大量研究,达成了许多共识,但在选择最佳的检查方式和治疗手段等方面尚存分歧。针对这些共识和分歧,作者查阅相关文献予以综述。     

小肝癌的临床诊断与个体化治疗

目的探讨小肝癌的临床诊断与个体化治疗方案。方法回顾性分析2007年1月至2009年1月在东莞市人民医院治疗的53例小肝癌患者的临床资料,总结小肝癌患者个体化诊治的经验。结果53例中手术切除35例,其中肿瘤位置较深而术中无法扪及18例,15例联合B超定位,3例术中体内标志联合CT／MRI定位。2例手术切除者因上消化道大出血及肝功能衰竭于术后2个月内死亡。微创治疗18例,其中射频消融术（RFA）13例,无水酒精注射术（PEI）3例,肝动脉化疗栓塞术（TA—CE）2例。手术切除组和微创治疗组3年生存率分别为75．2％和71．3％;1、2、3年复发率分别为13．3％、24．5％、37．1％和17．4％、31．8％、41．6％,差异均无统计学意义（均P〉0．05）。结论小肝癌的早期诊断应注意乙肝病史,同时结合多种检查及密切随访综合判断。术中B超和体内标志联合CT／MRI能准确定位微小病灶。小肝癌的治疗应制定个体化的治疗方案。     

Significance of telomerase activity in the diagnosis of small differentiated hepatocellular carcinoma

Precise diagnosis of well-differentiated hepatocellular carcinoma (HCC) is sometimes difficult to establish. Telomerase activity was examined by telomeric-repeat-amplification protocol (TRAP) in 37 HCC nodules smaller than 3 cm in diameter, including 24 fine-needle-aspiration biopsy specimens, 22 non-tumor chronic-liver-disease tissues (9 chronic hepatitis and 13 liver cirrhosis) and 3 normal liver tissues. Telomerase activity was assayed by serially diluted samples and quantitated by using an internal telomerase assay standard (ITAS). Telomerase activity was detected in all HCC and in 11 of 22 non-tumor chronic-liver-disease tissues. Normal liver samples had undetectable telomerase activity. Cut-off level of telomerase activity for its practical usage in HCC diagnosis was tentatively set for 0.6 μg liver protein/assay at 10-cell equivalent activity of a gastric-cancer cell line, MKN-1. This level was twice the highest activity in non-tumor chronic liver disease therefore, telomerase activity in all non-tumor liver samples was below this level. The telomerase-positive incidence exceeding this cut-off level was 73% (11/15) in well-differentiated HCC, 94% (16/17) in moderately differentiated HCC and 100% (5/5) in poorly differentiated HCC. Well-differentiated HCC showed low positivity by other diagnostic markers. 21% by AFP, 0% by PIVKA-II and 13% by angiography. The detection of telomerase activity may thus be a useful additional tool for precise and early diagnosis of small differentiated HCC, even when diagnosis is inconclusive by conventional techniques. Int. J. Cancer 74:141-147, 1997. © 1997 Wiley-Liss, Inc.     

The use of imaging in the diagnosis and staging of hepatobiliary malignancies

This review addresses the optimal use of imaging in the diagnosis, staging, and treatment planning of patients with hepatobiliary neoplasms. We focus on primary liver cancers, including hepatocellular carcinoma and intrahepatic cholangiocarcinoma as well as extrahepatic biliary tract malignancies, including hilar cholangiocarcinoma and gallbladder cancer. In each section, we provide an overview of the staging requirements for each disease followed by a discussion of various imaging modalities that can be used to optimally stage the disease and plan therapy.     

99Tcm奥曲肽核素显像诊断结直肠癌的研究

目的:探讨99Tcm奥曲肽显像对结直肠癌的诊断价值。方法:30例经内窥镜检查活检病理确诊的结直肠癌及6例非结直肠癌患者,术前进行腹部的99Tcm奥曲肽显像,以99Tcm直接标记的奥曲肽进行分析。结果:99Tcm奥曲肽显像检测30例结直肠癌4例阳性,26例阴性;6例非结直肠癌2例阳性,4例阴性。99Tcm奥曲肽显像对结直肠癌诊断的敏感度、特异度和准确度分别为13.33%、33.33%和22.22%。结论:99Tcm奥曲肽显像是一种无创、安全、经济的检查方法,但对结直肠癌诊断价值有限;需要用各种亚型的生长抑素受体和扩大样本量做进一步研究,以提高诊断的准确度。     

小肝癌的螺旋CT诊断--附18例报告

回顾性分析了 18例经手术病理证实的小肝癌于CT增强前及增强后动脉、静脉期和延迟期的影像表现。结果 18例小肝癌中 ,直径 <1cm者 2例 ,1 0～ 3 0cm者 16例 ,CT平扫时 15例表现为均匀低密度 ,3例为等密度 ,增强后动脉期 15例病灶有强化表现 ,均匀或不均匀 ,3例病灶无明显强化。门静脉期 14例表现为低密度病灶 ,延迟期 14例表现为低密度病灶。     

^99Tc^m奥曲肽核素显像诊断结直肠癌的研究

目的：探讨^99Tc^m奥曲肽显像对结直肠癌的诊断价值。方法：30例经内窥镜检查活检病理确诊的结直肠癌及6例非结直肠癌患者,术前进行腹部的^99Tc^m奥曲肽显像,以^99Tc^m直接标记的奥曲肽进行分析。结果：^99Tc^m奥曲肽显像检测30例结直肠癌4例阳性,26例阴性;6例非结直肠癌2例阳性,4例阴性。^99Tc^m奥曲肽显像对结直肠癌诊断的敏感度、特异度和准确度分别为13.33%、33.33%和22.22%。结论：^99Tc^m奥曲肽显像是一种无创、安全、经济的检查方法,但对结直肠癌诊断价值有限;需要用各种亚型的生长抑素受体和扩大样本量做进一步研究,以提高诊断的准确度。     

99m Tc标记抗肝癌单链抗体的生物分布及放射免疫显像的初步研究

目的:研究全新的抗肝癌单链抗体scFv-PE38在活体内的生物分布和对肝癌组织的亲和性。方法:双功能螯合剂cDTPA间接标记99mTc于抗体。分组建立荷瘤裸鼠模型,标记抗体注射试验组,对照组注射相当剂量的锝盐溶液。分别在各时间点进行SPECT平面显像,观察病灶浓集情况,计算T/NT比值;并分离各主要组织器官测定放射性,计算各时间点组织摄取和瘤肝比。结果:注射30分钟后肿瘤开始显像,24小时显像最明显,T/NT达1.89±0.84;36小时各组织器官中肿瘤摄取最高,瘤肝比达1.64±1.12。结论:该抗体经标记后在活体内表现出对瘤组织的特异亲和性,为抗体应用于诊治奠定了初步的实验基础。     

小肝细胞癌与小肝血管瘤螺旋CT三期扫描的鉴别诊断

目的分析小肝细胞癌(SHCC)和小肝血管瘤(SHCH)在螺旋CT动脉期、门静脉期和延迟期的表现特点,探讨二者的鉴别要点。方法38例SHCC共41个病灶,35例SHCH共45个病灶,记录病灶的增强特点,测定动脉期均匀强化病灶的CT值,并进行比较。结果41个SHCC病灶中,有20个动脉期呈高密度,门静脉期和延迟期呈低密度;6个动脉期呈高密度,门静脉期呈等密度,延迟期呈低密度;3个动脉期和门静脉期呈高密度,延迟期呈低密度;5个动脉期呈均匀高密度,门静脉期和延迟期呈等密度;3个动脉期呈等密度,门静脉和延迟期呈低密度;4个动脉期、门静脉期和延迟期均呈低密度。45个SHCH病灶中,有27个动脉期见边缘结节状高密度,门静脉期高密度结节扩大,向病灶中央填充,延迟期呈等密度或均匀高密度;9个动脉期和门静脉期均呈均匀高密度,延迟期呈等或高密度;3个动脉期呈均匀高密度,门静脉期和延迟期呈等密度;6个动脉期和门静脉期呈低密度,延迟期病灶部分充填仍呈低密度。动脉期均匀强化的SHCC和SHCH的CT增强值分别为(40.4±15.5)HU和(102.8±18.9)HU,二者差异有统计学意义(P<0.01)。结论螺旋CT三期扫描中大多数SHCC和SHCH有典型表现,其诊断准确性高,但少数病变表现不典型,鉴别诊断有一定困难,应结合MR I、超声、核素扫描及临床等进一步明确诊断。     

肝超声造影监测和早期诊断微小肝癌的应用价值

背景与目的：我国肝癌发病率高,原发性肝癌常在肝硬化的基础上发生,早期诊断较为困难。本研究应用实时超声造影对肝癌高危患者进行定期跟踪监测,探讨其早期发现和诊断微小肝癌的临床应用价值。方法：2011年2月-2013年11月针对320例肝癌高危患者进行定期的肝常规超声检查和追踪定位的肝超声造影检查,根据肝内病灶在超声造影不同时相的增强表现特点鉴别诊断其良恶性。结果：320例肝癌高危患者定期随访中,经肝超声造影发现和诊断微小肝细胞癌20例,并经手术病理证实,包括直径≤1.0 cm肝癌7例、1.1~2.0 cm肝癌13例。其中6例(30.0%)呈不典型的“快进同出”型表现;病灶小,灰阶超声上呈等回声是超声造影表现不典型的主要因素。结论：常规超声和超声造影对肝癌高危患者的定期跟踪监测,可早期发现微小肝癌,使患者得到及时治疗。     

The usefulness of 99mTc-tetrofosmin SPECT scintimammography in the detection of small size primary breast carcinomas

The aim of this study was to evaluate the usefulness of supine 99mTc-tetrofosmin SPECT in the detection of small size breast carcinomas (BC), for which planar scintimammography has showed a low sensitivity. We studied 93 patients with breast lesions 相似文献   

99mTc-甲氧异腈显像在分化型甲状腺癌转移灶诊断中的临床应用

目的:探讨99mTc-甲氧异腈(MIBI)显像在分化型甲状腺癌(DTC)转移灶诊断中的临床应用价值.方法:72例接受131I治疗的分化型甲状腺癌随访患者,以甲状腺球蛋白增高阈值＞10ng/ml为标准分为实验组(n=35)和对照组(n=37),常规行131I全身扫描(WBS),同时以99mTc-MIBI作为显像剂行核素肿瘤显像.以核素显像感兴趣区(ROI)技术,测定放射性(T/NT)比值,进行半定量分析;比较99mTc-MIBI显像及131I全身显像在诊断甲状腺癌转移灶灵敏性、特异性、准确性上的差异.结果:实验组,99mTc-MIBI显像和131 I全身显像T/NT比值分别为3.24 ±0.43和5.35 ±0.32,有明显差异;对照组T/NT比值分别为1.31 ±0.18和1.26±0.25,无明显差异;两种方法诊断分化型甲状腺癌转移灶的灵敏性、特异性、准确性分别为24.52％、64.28％、32.83％和92.45％、57.14％、85.07％.结论:99mTc-MIBI显像诊断分化型甲状腺癌转移灶灵敏性及准确性均低于131I全身显像,特异性无明显差异,但99mTc-MIBI显像可作为131I全身显像阴性分化型甲状腺癌随访方法的有益补充.     

射频消融在小肝癌治疗中的地位

射频消融是目前最先进和最有效的肝癌局部消融技术之一,在临床的应用也逐渐广泛,为小肝癌的治疗带来了新的希望和新的治疗模式.射频消融已被认为是小肝癌继外科切除术和肝脏移植术之后的根治性治疗方法.本文回顾了射频消融的原理及其发展:总结和评价了射频消融在小肝癌临床治疗中的疗效、安全性和综合应用情况,并与手术切除进行了对比;提出了射频消融存在的问题,展望了其进一步发展方向.笔者认为射频消融治疗小肝癌安全性高、并发症少、适应证广,疗效与手术切除相近,但评价其长期疗效还需要更长时间的随访观察和更多的前瞻性随机对照研究.     

Recent advances in imaging hepatocellular carcinoma: diagnosis, staging and response assessment: functional imaging

Historically, nuclear medicine has had an important role in the differential diagnosis of liver tumors but has been largely superseded by other forms of conventional imaging, in particular computed tomographic portography. It remains helpful in difficult cases because it has characteristic features in both hepatocellular carcinoma (HCC) and benign conditions. 131I is an important therapeutic tool. FDG-PET is useful in certain cases, especially for finding metastases and monitoring response to therapy.     

Ultrasound diagnosis of hepatocellular carcinoma

Nowadays, ultrasound has been widely used in clinical practice of gastroenterology. A recently developed ultrasound apparatus with a higher resolution of image and less artifacts makes it possible to find out a small HCC sized about 1.0 cm. Moreover, a new convex type of probe with a wide field of view enables us to detect a small HCC locating in the upper part of the right lobe which has been done with difficulty before. Early diagnosis of HCC by detecting a small mass lesion will be carried out reliably by a modern ultrasound modality.