肝癌患者肝移植术前后正电子发射计算机体层摄影-CT检查的临床应用价值

目的 对^18氟-脱氧葡萄糖正电子发射计算机体层摄影-CT（^18F-FDGPET-CT）在肝癌患者肝移植术前评估并对术后复发病灶的早期发现中的价值进行评估。方法 回顾性分析了21例（34例次）肝癌患者拟行或已行肝移植手术患者的临床和^18F-FDG PET-CT的影像学资料。肝移植术前进行^18F-FDG PET-CT扫描者10例（12例次），其中8例（8例次）PET检查的目的是肝移植术前评估，2例（4例次）行PET检查的目的是了解介入综合治疗或手术切除后肝癌病灶的灭活情况及全身转移情况。肝移植术后进行^18F-FDG PET-CT扫描者11例（22例次），检查目的是了解肝移植术后肿瘤有无复发转移，术后行PET检查距离肝移植手术13之间的平均时间为8-68个月。结果 （1）肝移植术前评估的8例中有2例PET显示全身各部均未发现转移性病灶者，均按期进行了肝移植手术；有2例PET显示转移灶位于拟手术野区域内，也按期进行了移植手术（术中对局部的转移灶进行了外科清扫）；有4例患者因已有不同程度的远处转移，放弃肝移植手术，而改用介入或其他内科治疗。（2）肝移植术后进行PET-CT扫描者11例（22例次），其中2例术后行PET检查未发现肿瘤复发及全身其他部位的转移灶；1例术后发现霉菌性脑脓肿；其余8例（19例次）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、肺内转移及多部位多发淋巴结转移、骨转移、脾脏内转移、胸壁胸膜转移、胸椎椎间孔等处转移征象。结论 ^18F-FDG PET-CT的全身性扫描兼有对肿瘤显示高敏感性的优势，在肝移植术前评估和术后早期发现复发病灶均取得了较好的效果，部分患者因此改变了诊断分期及相应的治疗计划，它在肝移植的术前评估中起着重要的作用。

The application value of positron emission tomography-CT in clinical assessment of pre- and post-operations of liver transplantation in patients with hepatocellular carcinoma

Objective To assess the cli ni cal value of 18-fluorodeoxy glucose(~18F-FDG) positron emission tomogra phy-computer tomography (PET-CT) in preoperative evaluation of hepatocellular carcinoma patients awaiting liver transplantation and in early discovery of the recurrent focus in patients after liver transplantation. Methods This was a retrospective study of 21 patients (34 times) with hepatocel lular carcinoma who underwent ~18F-FDG PET-CT. The clinical materials of preoperation and postoperation were analyzed with ~18F-FDG PET-CT images . A total of 12 ~18F-FDG PET-CT examinations in 10 patients were done pr eoperatively. Among them, the purpose of 8 ~18F-FDG PET-CT examinations in 8 patients was preoperative evaluation, and the purpose of 4 ~18F-FDG P ET-CT examinations in 2 patients was to define the deactivation and metastasis of hepatoma in the whole body after adjuvant therapy. 22 ~18F-FDG PET-CT examinations in 11 postoperative patients was performed to determine the recurr ence and metastasis. The average interval between postoperative PET-CT examina tion and operations was 8.68 months. Results (1) PET ex aminations in 2 of the 8 patients for preoperative evaluations showed no evidenc e of recurrence and/or metastasis, so they accepted the liver transplantations a s scheduled; while ~18F-FDG PET-CT examinations in 6 of the 8 patients di scovered distinct extents of metastasis, 2 of them accepted the liver transplant ations because of the metastasis were situated inside the operating field, but 4 of them gave up the operation because of the different extents of distant metas tasis and were shifted to interventional therapy and other treatments. (2) 22 ~18F-FDG PET-CT examinations in 11 patients were studied after the liver transplantations. Among them, 2 patients were discovered no focus of metastasis , 1 patient was detected to have mycotic brain abscess, and 4 patients showed re currence in the grafted liver. In addition, bolts of malignancy in the hepatic veins of double lobes and in the inferior vena cava, lung metastasis, metastasis in lymph nodes, osseous metastasis, spleen metastasis, parietal pleura metastas is, and metastasis of intervertebral foramen at thoracic vertebra were revealed . Conclusion PET-CT proved to have significant accuracy in assessing tumor-node-metastasis system staging. Two significant advantage s of ~18F-FDG PET-CT were the general scan of whole body and hypersensiti ve manifestation to carcinoma, and these diagnostic advantages result in the cha nge of tumor staging and therapic planning in a substantial number of patients.