Fartoux Laetitia, Balogova Sona, Nataf Valérie, Kerrou Khaldoun, Huchet Virginie, Rosmorduc Olivier, Talbot Jean-Noël
Department of Hepatology, Hospital Saint-Antoine (AP-HP), France.
Nucl Med Commun. 2012 Jul;33(7):757-65. doi: 10.1097/MNM.0b013e328350fb9f.
Presurgical identification of patients at high risk for early recurrence of hepatocellular carcinoma (HCC) after resection could warrant additional therapies. F-fluorodeoxyglucose (FDG) uptake by the tumour on preoperative PET can predict HCC recurrence after resection as effectively as poor differentiation or presence of microvascular invasion (MVI) on postsurgical histology. A better sensitivity for the detection of HCC nodules has been reported with F-fluorocholine (FCH), a PET tracer of lipid metabolism. This pilot study aimed to compare preoperative FDG and FCH PET/CT for predicting early recurrence of unifocal HCC, occurring within 6 months after surgical resection.
FDG and FCH tumour uptakes were assessed on preoperative PET/CT by two masked readers. On FCH PET/CT, a photopenic lesion and a hot focus were considered as indicative of malignancy. During postoperative follow-up, recurrence was searched for by regularly performing CT and MRI.
In 11 consecutive HCC patients, the detection rate was greater with FCH (80%) than with FDG (27%). After resection, the overall recurrence rate was 55%. Early recurrence occurred in four patients, who were the only ones with an FDG-positive and FCH-photopenic tumour, with a significant reduction in disease-free survival. On postsurgical histology, those four patients also presented with MVI and satellite nodules. Histological differentiation and capsule disruption appeared less accurate than PET/CT or MVI in predicting early recurrence.
In unifocal HCC, the FCH photopenic pattern was associated with MVI and predicted early HCC recurrence after surgical resection as accurately as did an FDG uptake. Larger studies with FCH are warranted.
术前识别肝细胞癌（HCC）切除术后早期复发的高危患者可能需要额外的治疗。术前PET上肿瘤对F-氟脱氧葡萄糖（FDG）的摄取与术后组织学上的低分化或微血管侵犯（MVI）一样，能够有效预测HCC切除术后的复发情况。据报道，脂质代谢的PET示踪剂F-氟胆碱（FCH）对HCC结节的检测具有更高的灵敏度。本前瞻性研究旨在比较术前FDG和FCH PET/CT对预测单灶性HCC手术切除后6个月内早期复发的效果。
由两名盲法阅片者对术前PET/CT上的FDG和FCH肿瘤摄取情况进行评估。在FCH PET/CT上，放射性缺损灶和热区被视为恶性的指标。术后随访期间，定期进行CT和MRI检查以寻找复发情况。
在11例连续的HCC患者中，FCH的检测率（80%）高于FDG（27%）。切除术后，总体复发率为55%。4例患者出现早期复发，他们是仅有的FDG阳性且FCH放射性缺损的肿瘤患者，无病生存期显著缩短。在术后组织学检查中，这4例患者还存在MVI和卫星结节。在预测早期复发方面，组织学分化和包膜破裂似乎不如PET/CT或MVI准确。
在单灶性HCC中，FCH放射性缺损模式与MVI相关，并且在预测手术切除后早期HCC复发方面与FDG摄取一样准确。有必要开展更大规模的FCH研究。
