介入治疗后CT表现不典型的肝癌残留和复发病灶的早期诊断

目的探讨MRI、PET/CT早期诊断肝细胞癌(HCC)介入治疗后CT表现不典型的残留及复发病灶的价值。方法回顾性分析19例接受介入治疗的HCC患者的资料,术后定期复查发现甲胎蛋白(AFP)升高,螺旋CT三期增强扫描呈不典型表现,经MR和(或)PET/CT检查发现HCC残留和复发病灶。对所有病灶均获得病理结果。比较治疗前、后的AFP。结果对19例HCC患者行MR检查25例次,发现31个结节;PET/CT检查14例次,发现17个结节,MRI、PET/CT联合检查共发现35个结节;诊断HCC残留和复发病灶31个,直径0.90～2.50cm,平均(1.50±0.32)cm。介入治疗后1、4周,AFP明显降低,与治疗前相比差异均有统计学意义(P均<0.05)。MRI、PET/CT诊断肝内残留和复发病灶的敏感度分别为87.10%(27/31)、89.47%(17/19),MRI联合PET/CT的诊断敏感度为100%(31/31)。结论 MRI、PET/CT均能较好地早期诊断HCC患者介入治疗后CT表现不典型的残留及复发病灶;MRI联合PET/CT能进一步提高早期诊断率,减少假阴性和假阳性。

Early diagnosis of residual and recurrent tumor of hepatocellular carcinoma with atypical CT features after interventional therapies

Objective To investigate the optimal strategies for early diagnosis of residual and recurrent tumor of hepatocellular carcinoma (HCC) with atypical CT features after interventional therapies. Methods Nineteen patients with HCC after interventional therapies were enrolled. The alpha-fetoprotein (AFP) level of all the patients rose during regular postoperative following-up. Triple-phase spiral CT scan did not detect any intrahepatic lesions due to atypical CT features of HCC, while abdominal MRI and/or PET/CT were performed and residual or recurrent lesions were found. All the lesions were confirmed pathologically and received interventional therapies according to MRI and/or PET/CT findings. The pre- and post-treatment AFP levels were compared. Results Thirty-one nodules were found in 25 procedures in 19 patients with MRI and 17 in 14 procedures with PET/CT. Thirty-one residual or recurrent lesions of HCC were diagnosed by MRI and PET/CT. The diameters of these lesions ranged from 0.90 cm to 2.50 cm (mean cm). All the lesions received interventional therapies, and postoperative following-up showed that AFP level decreased obviously compared with pre-treatment (both P<0.05). The sensitivity of MRI, PET/CT and MRI combined with PET/CT in early diagnosis of residual or recurrent lesions of HCC was 87.10% (27/31), 89.47% (17/19) and 100% (31/31), respectively. Conclusion Both MRI and PET/CT are useful for early detection of residual and recurrent tumor of HCC with atypical CT features after interventional therapies. MRI combined with PET/CT can result better sensitivity of early diagnosis and reduce false positive and false negative.