Department of Nuclear Medicine, Medical Physics, Radiology, PET Centre, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, Rovigo, Italy.
Mol Imaging Biol. 2010 Apr;12(2):139-44. doi: 10.1007/s11307-009-0249-5. Epub 2009 Jul 22.
The most common malignancy affecting the liver is metastasis from a wide variety of tumors, particularly those of gastrointestinal origin. Successful surgical removal of a solitary liver metastasis may significantly extend survival and optimal preoperative assessment in this regard is a mandatory prerequisite for proper patient selection. The addition of positron emission tomography/computed tomography (PET/CT) to other more conventional imaging procedures (e.g., ultrasound (US), CT, and magnetic resonance) has the potential to greatly improve the selection process by the combination of high-resolution anatomy afforded by CT directly combined with the functional scintigraphic map of intra- and extrahepatic lesions depicted by 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-PET. In this study, we assess the additional value of PET/CT in the management strategy of patients with solitary liver metastasis from colorectal and other cancers identified by conventional imaging methods.
We evaluated 43 consecutive patients (17 males, 26 females, mean age 53 +/- 6 years) with known solitary liver metastasis. This sample consisted of 18 patients with colorectal cancer, 15 with nonsmall cell lung cancer, six with breast carcinoma, and four ovarian cancers. In addition to contrast-enhanced CT and US, all patients were studied with FDG-PET/CT before surgery. PET/CT was performed within 3 weeks of the initial diagnosis and the scans were read by two experienced radiologists/nuclear medicine specialists blinded to the clinical data. A final diagnosis was obtained at surgery in 31 patients, by fine needle biopsy in five, and long-term clinical, biochemical, and follow-up imaging in seven patients.
In 12 out of 43 patients (28%), PET/CT resulted in restaging disease and a change in therapy. Twenty-two of 31 patients with confirmed solitary liver lesions (71%) were disease-free, eight of 31 (26%) developed a new recurrence, and one of 31 (3%) died from disease progression over a 17 +/- 6-month follow-up interval. Nine of 12 patients (75%) with multiple metastases demonstrated by FDG-PET/CT were alive with disease and three of 12 (25%) deceased due to disease progression (p < 0.01) over a 17 +/- 6-month follow-up interval.
The addition of FDG-PET/CT to the routine assessment of patients with liver metastasis has a significant impact on disease staging and selection of suitable candidates for solitary liver metastasis resection and outcome.
最常见的肝脏恶性肿瘤是来自多种肿瘤的转移，尤其是胃肠道来源的肿瘤。单发肝脏转移瘤的成功手术切除可显著延长患者的生存时间，而这方面的最佳术前评估是正确选择患者的强制性前提条件。正电子发射断层扫描/计算机断层扫描（PET/CT）与其他更常规的成像程序（如超声（US）、CT 和磁共振）相结合，通过 CT 直接提供的高分辨率解剖结构与 2-脱氧-2-[F-18]氟-D-葡萄糖（FDG）-PET 所示的肝内和肝外病变的功能闪烁图相结合，有可能极大地改善选择过程。在这项研究中，我们评估了 PET/CT 在通过常规成像方法确定的单发肝脏转移瘤患者的管理策略中的附加价值。
我们评估了 43 例连续患者（17 例男性，26 例女性，平均年龄 53±6 岁），这些患者已知有单发肝脏转移瘤。该样本包括 18 例结直肠癌患者、15 例非小细胞肺癌患者、6 例乳腺癌患者和 4 例卵巢癌患者。除了增强 CT 和 US 检查外，所有患者在手术前均进行了 FDG-PET/CT 检查。PET/CT 在初始诊断后 3 周内进行，两名有经验的放射科医生/核医学专家对扫描结果进行了盲读，这些专家不知道临床数据。31 例患者中的 21 例在手术中获得了最终诊断，5 例通过细针活检获得，7 例通过长期临床、生化和随访影像学获得。
在 43 例患者中有 12 例（28%），PET/CT 导致疾病重新分期并改变了治疗方法。在 31 例有明确单发肝脏病变的患者中，22 例（71%）无疾病，8 例（26%）出现新的复发，1 例（3%）死于疾病进展，随访时间为 17±6 个月。在 FDG-PET/CT 显示有多个转移的 12 例患者中，9 例（75%）仍患有疾病，12 例中有 3 例（25%）死于疾病进展（p<0.01），随访时间为 17±6 个月。
在肝脏转移瘤患者的常规评估中加入 FDG-PET/CT，对疾病分期和选择适合单发肝脏转移瘤切除的合适患者以及结果有显著影响。
