Pant Vineet, Sen Ishita B, Soin Arvinder S
Department of Nuclear Medicine, Fortis Memorial Research Institute, Medanta-The Medicity, Gurgaon, India.
Nucl Med Commun. 2013 Aug;34(8):749-57. doi: 10.1097/MNM.0b013e3283622eef.
The aim of the study was to evaluate the role of F-fluorodeoxyglucose PET computed tomography (F-FDG PET CT) as an independent prognostic indicator in patients with hepatocellular carcinoma (HCC).
PET contrast-enhanced CT scans of 100 consecutive patients with HCC were reviewed retrospectively. Patients were asked to fast for 6 h before the study and blood glucose levels were monitored and ensured to be less than 200 mg/dl before injection of F-FDG. After administering the F-FDG injection (370-550 MBq) patients were instructed to rest comfortably for 45-60 min. All images were acquired using a dedicated GE Discovery PET/CT scanner. The PET CT scans of all the patients were reported separately by two nuclear medicine physicians. A stage-wise analysis of the compiled data was carried out. Lesions that showed standardized uptake values greater than background activity (activity in adjacent normal liver tissue) were defined as having increased F-FDG uptake. Pearson's χ -test or the Kruskal-Wallis test was used to assess statistical significance. A P value less than 0.05 was taken as significant.
In this retrospective study of 100 HCC patients, a radiologically higher-stage disease was found more commonly in patients with F-FDG-avid primary tumors (P<0.001), whereas a lower-stage disease was found in patients with non-F-FDG-avid primary tumors. The non-F-FDG-avid tumors also showed lower incidence of metastatic disease and portal vein thrombosis (P<0.001). The histopathological findings of the patients who underwent liver transplantation demonstrated that a higher-grade tumor was more common in the F-FDG-avid tumor group than in the non-F-FDG-avid tumor group (P<0.05).
An F-FDG PET CT scan can be used not only for staging but also as a tool for preoperative prediction of cellular differentiation in patients with HCC. The F-FDG uptake seen on a PET scan can serve as a molecular signature for management decisions and can be used as an independent and significant prognostic factor in patients with HCC.
本研究旨在评估氟脱氧葡萄糖正电子发射断层扫描计算机断层扫描（F-FDG PET CT）在肝细胞癌（HCC）患者中作为独立预后指标的作用。
回顾性分析100例连续HCC患者的PET对比增强CT扫描结果。研究前患者需禁食6小时，监测血糖水平，并确保在注射F-FDG前血糖水平低于200mg/dl。注射F-FDG（370-550MBq）后，指导患者舒适休息45-60分钟。所有图像均使用专用的GE Discovery PET/CT扫描仪采集。所有患者的PET CT扫描结果由两名核医学医师分别报告。对汇总数据进行分期分析。标准化摄取值高于背景活性（相邻正常肝组织活性）的病变定义为F-FDG摄取增加。采用Pearson卡方检验或Kruskal-Wallis检验评估统计学意义。P值小于0.05被认为具有统计学意义。
在这项对100例HCC患者的回顾性研究中，F-FDG摄取阳性的原发性肿瘤患者中，放射学分期较高的疾病更为常见（P<0.001），而F-FDG摄取阴性的原发性肿瘤患者中，分期较低的疾病更为常见。F-FDG摄取阴性的肿瘤转移疾病和门静脉血栓形成的发生率也较低（P<0.001）。接受肝移植患者的组织病理学结果显示，F-FDG摄取阳性肿瘤组的高级别肿瘤比F-FDG摄取阴性肿瘤组更常见（P<0.05）。
F-FDG PET CT扫描不仅可用于分期，还可作为HCC患者术前预测细胞分化的工具。PET扫描上观察到的F-FDG摄取可作为管理决策的分子标志，并可作为HCC患者独立且重要的预后因素。
