F-18氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（F-18 FDG PET/CT）在肝细胞癌介入治疗后早期治疗反应评估中的应用价值
Usefulness of F-18 FDG PET/CT in the Evaluation of Early Treatment Response After Interventional Therapy for Hepatocellular Carcinoma.
作者信息
Kim Sung Hoon, Won Kyoung Sook, Choi Byung Wook, Jo Il, Zeon Seok Kil, Chung Woo Jin, Kwon Jung Hyeok
机构信息
Department of Nuclear Medicine, Keimyung University, School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712 Republic of Korea.
Department of Internal Medicine, Keimyung University, School of Medicine, Daegu, Korea.
出版信息
Nucl Med Mol Imaging. 2012 Jun;46(2):102-10. doi: 10.1007/s13139-012-0138-8. Epub 2012 Apr 28.
PURPOSE
This retrospective study investigated the usefulness of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) after interventional therapy for hepatocellular carcinoma (HCC).
METHODS
Between March 2007 and November 2010, 31 patients (24 men, 7 women; mean age, 61.8 ± 11.0 years) with 45 lesions underwent PET/CT within 1 month after interventional therapy for HCC. Twenty-six patients with 40 lesions underwent transcatheter arterial chemoembolization (TACE), two patients with 2 lesions underwent radiofrequency ablation (RFA), and three patients with 3 lesions underwent percutaneous ethanol injection therapy (PEIT). Patients with a history of previous interventional therapy were excluded. Visual analysis was graded as positive when FDG was observed as an eccentric, nodular, or infiltrative pattern, and negative in case of isometabolic, hypometabolic, or rim-shaped uptake. For quantitative analysis, the standardized uptake value (SUV) was measured by region of interest technique. Maximum SUV (SUVmax) was assessed, and the ratio of SUVmax of tumor to mean SUV of normal liver (TNR) was calculated. The patients were divided into two groups, with and without residual tumor, based on 6-month clinical follow-up with serum alpha-fetoprotein and contrast-enhanced abdominal CT.
RESULTS
Of the 45 lesions, 24 were classified in the residual tumor group and the other 21 lesions in the no residual tumor group. No residual tumor was detected after RFA or PEIT. By visual analysis, the respective values for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.5, 71.4, 77.8, 83.3, and 80.0 %. However, there were no significant differences in the SUVmax and TNR between the two groups.
CONCLUSIONS
It is suggested that FDG PET/CT may play a role in the evaluation of early treatment response after interventional therapy for HCC. The results indicate that FDG PET/CT visual analysis may be more useful than quantitative analysis. Further prospective studies with a large number of patients and established protocol are needed to substantiate our results.
目的
本回顾性研究探讨了F-18氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在肝细胞癌（HCC）介入治疗后的应用价值。
方法
2007年3月至2010年11月期间，31例患者（24例男性，7例女性；平均年龄61.8±11.0岁）共45个病灶在HCC介入治疗后1个月内接受了PET/CT检查。26例患者40个病灶接受了经动脉化疗栓塞术（TACE），2例患者2个病灶接受了射频消融术（RFA），3例患者3个病灶接受了经皮乙醇注射治疗（PEIT）。排除既往有介入治疗史的患者。视觉分析中，若FDG呈偏心、结节状或浸润性表现则分级为阳性，若呈等代谢、低代谢或边缘摄取则为阴性。定量分析采用感兴趣区技术测量标准化摄取值（SUV）。评估最大SUV（SUVmax），并计算肿瘤SUVmax与正常肝脏平均SUV的比值（TNR）。根据血清甲胎蛋白和腹部增强CT进行6个月的临床随访，将患者分为有残留肿瘤组和无残留肿瘤组。
结果
45个病灶中，24个病灶归为残留肿瘤组，另外21个病灶归为无残留肿瘤组。RFA或PEIT后未检测到残留肿瘤。视觉分析的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为87.5%、71.4%、77.8%、83.3%和80.0%。然而，两组间SUVmax和TNR无显著差异。
结论
提示FDG PET/CT可能在HCC介入治疗后早期治疗反应的评估中发挥作用。结果表明，FDG PET/CT视觉分析可能比定量分析更有用。需要进一步开展大量患者参与的前瞻性研究并建立规范方案以证实我们的结果。
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