Seo Hyo Jung, Choi Yun Jung, Kim Hyun Jeong, Jeong Yong Hyu, Cho Arthur, Lee Jae Hoon, Yun Mijin, Choi Hye Jin, Lee Jong Doo, Kang Won Jun
Division of Nuclear Medicine, Department of Radiology, Yonsei University College of Medicine, Seongsanno250, Seodaemun-gu, Seoul, 120-752 Korea.
Division of Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Nucl Med Mol Imaging. 2011 Sep;45(3):203-11. doi: 10.1007/s13139-011-0099-3. Epub 2011 Aug 5.
Bone metastasis from hepatocellular carcinoma (HCC) can present with soft tissue formation, resulting in oncologic emergency. Contrast-enhanced FDG PET/CT and bone scintigraphy were compared to evaluate characteristics of bone metastases with or without soft tissue formation from HCC.
Of 4,151 patients with HCC, 263 patients had bone metastases. Eighty-five patients with bone metastasis from HCC underwent contrast-enhanced FDG PET/CT. Fifty-four of the enrolled subjects had recent (99m)Tc-HDP bone scintigraphy available for comparison. Metastatic bone lesions were identified with visual inspection on FDG PET/CT, and maximum standardized uptake value (SUVmax) was used for the quantitative analysis. Confirmation of bone metastasis was based on histopathology, combined imaging modalities, or serial follow-up studies.
Forty-seven patients (55%) presented with soft tissue formation, while the remaining 38 patients presented without soft tissue formation. Frequent sites of bone metastases from HCC were the spine (39%), pelvis (19%), and rib cage (14%). The soft-tissue-formation group had more frequent bone pain (77 vs. 37%, p < 0.0001), higher SUVmax (6.02 vs. 3.52, p < 0.007), and higher incidence of photon defect in bone scintigraphy (75 vs. 0%) compared to the non-soft-tissue-formation group. FDG PET/CT had higher detection rate for bone metastasis than bone scintigraphy both in lesion-based analysis (98 vs. 53%, p = 0.0015) and in patient-based analysis (100 vs. 80%, p < 0 .001).
Bone metastasis from HCC showed a high incidence of soft tissue formation requiring emergency treatment. Although the characteristic findings for soft tissue formation such as photon defect in bone scintigraphy are helpful in detection, overall detectability of bone metastasis is higher in FDG PET/CT. Contrast-enhanced PET/CT will be useful in finding and delineating soft-tissue-forming bone metastasis from HCC.
肝细胞癌（HCC）骨转移可伴有软组织形成，导致肿瘤急症。对比增强FDG PET/CT和骨闪烁显像用于评估HCC骨转移伴或不伴软组织形成的特征。
在4151例HCC患者中，263例发生骨转移。85例HCC骨转移患者接受了对比增强FDG PET/CT检查。其中54例受试者近期有（99m）Tc-HDP骨闪烁显像结果可供比较。通过FDG PET/CT的视觉检查确定转移性骨病变，并使用最大标准化摄取值（SUVmax）进行定量分析。骨转移的确认基于组织病理学、联合成像方式或系列随访研究。
47例患者（55%）出现软组织形成，其余38例患者未出现软组织形成。HCC骨转移的常见部位是脊柱（39%）、骨盆（19%）和胸廓（14%）。与非软组织形成组相比，软组织形成组骨痛更常见（77%对37%，p<0.0001），SUVmax更高（6.02对3.52，p<0.007），骨闪烁显像中光子缺损的发生率更高（75%对0%）。在基于病变的分析（98%对5三%，p=0.0015）和基于患者的分析（100%对80%，p<0.001）中，FDG PET/CT对骨转移的检出率均高于骨闪烁显像。
HCC骨转移伴有软组织形成的发生率较高，需要紧急治疗。尽管骨闪烁显像中光子缺损等软组织形成的特征性表现有助于检测，但FDG PET/CT对骨转移的总体可检测性更高。对比增强PET/CT将有助于发现和描绘HCC伴软组织形成的骨转移。
