Carnaghi Carlo, Tronconi Maria Chiara, Rimassa Lorenza, Tondulli Luca, Zuradelli Monica, Rodari Marcello, Doci Roberto, Luttmann Fabio, Torzilli Guido, Rubello Domenico, Al-Nahhas Adil, Santoro Armando, Chiti Arturo
Department of Oncology, IRCCS Humanitas, Rozzano-Milano, Italy.
Nucl Med Rev Cent East Eur. 2007;10(1):12-5.
Neoadjuvant chemotherapy has been successfully used in the treatment of patients with colorectal liver metastases. The selection of patients for surgical resection after chemotherapy still poses a significant clinical challenge. (18)F-FDG PET is a useful tool in the assessment of liver metastases but the data regarding its sensitivity after chemotherapy is scarce. Our aim was to assess the value of this imaging modality in the selection of patients with colorectal liver metastasis for surgery following adjuvant chemotherapy.
We reviewed the diagnostic performances of (18)F-FDG PET and contrast-enhanced CT scan data from patients with colorectal liver metastases following treatment with chemotherapy. Nineteen patients (12 males, 7 females; median age 61 years; range 41-79) were evaluated. Chemotherapy regimens were: FOLFOX (14 patients), FOLFIRI (3 patients), 5-FU/FA (1 patient) and UFT-irinotecan-oxaliplatin (1 patient). Median time between end of chemotherapy and CT scan was 3.4 weeks, between end of chemotherapy and PET was 5.9 weeks and between end of chemotherapy and surgery was 9.9 weeks. All patients underwent surgery and had histopathological confirmation of liver lesions. Nine patients had segmentectomy, 2 patients had wedge resection, 5 patients had right hepatectomy and 3 patients had explorative laparotomy with liver biopsies.
Data from all 19 patients, comprising 65 liver lesions, were confirmed by histo-pathology. Results on a per-lesion basis showed a sensitivity of 62% for (18)F-FDG PET and 70% for CT scan. A complete agreement between (18)F-FDG PET or CT scan and histology was documented in 5 and 3 patients, respectively. The sensitivity of (18)F-FDG PET was shown to increase for lesions larger than 1 cm (74% vs. 18%).
These results suggest that (18)F-FDG PET and CT scan have sub-optimal sensitivity in the evaluation of colorectal liver lesions after neo-adjuvant chemotherapy, especially for lesions < 1 cm. The combined use of the two imaging techniques does not significantly increase the sensitivity of lesion detection.
新辅助化疗已成功应用于结直肠癌肝转移患者的治疗。化疗后手术切除患者的选择仍然是一项重大的临床挑战。（18）F-FDG PET是评估肝转移的有用工具，但关于其化疗后敏感性的数据很少。我们的目的是评估这种成像方式在辅助化疗后选择结直肠癌肝转移患者进行手术中的价值。
我们回顾了化疗后结直肠癌肝转移患者的（18）F-FDG PET和增强CT扫描数据的诊断性能。评估了19例患者（12例男性，7例女性；中位年龄61岁；范围41-79岁）。化疗方案为：FOLFOX（14例患者）、FOLFIRI（3例患者）、5-FU/FA（1例患者）和UFT-伊立替康-奥沙利铂（1例患者）。化疗结束至CT扫描的中位时间为3.4周，化疗结束至PET的中位时间为5.9周，化疗结束至手术的中位时间为9.9周。所有患者均接受了手术，并对肝脏病变进行了组织病理学确认。9例患者进行了节段切除术，2例患者进行了楔形切除术，5例患者进行了右半肝切除术，3例患者进行了剖腹探查并取肝脏活检。
所有19例患者的65个肝脏病变的数据均经组织病理学证实。基于每个病变的结果显示，（18）F-FDG PET的敏感性为62%，CT扫描的敏感性为70%。分别有5例和3例患者记录了（18）F-FDG PET或CT扫描与组织学之间的完全一致性。对于大于1 cm的病变，（18）F-FDG PET的敏感性显示增加（74%对18%）。
这些结果表明，（18）F-FDG PET和CT扫描在评估新辅助化疗后的结直肠癌肝病变时敏感性欠佳，尤其是对于小于1 cm的病变。两种成像技术联合使用并不能显著提高病变检测的敏感性。
