Bak-Fredslund Kirstine P, Keiding Susanne, Villadsen Gerda E, Kramer Stine, Schlander Sven, Sørensen Michael
Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark.
Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Liver Int. 2020 Feb;40(2):447-455. doi: 10.1111/liv.14293. Epub 2019 Nov 25.
BACKGROUND & AIMS: Positron emission tomography (PET) with the liver-specific tracer [ F]-fluoro-2-deoxy-D-galactose ( F-FDGal) can be used for imaging of hepatocellular carcinoma (HCC). Curative intended and locoregional treatments of HCC require absence of extrahepatic disease. The aim of this prospective study was to determine whether adding F-FDGal PET/CT to standard work-up changes the planned treatment in patients with HCC deemed suitable for curative or locoregional treatment.
Fifty patients with HCC were included at our tertiary liver centre. The primary study outcome was a change in treatment strategy. A subgroup of 29 patients was also examined with [ F]-fluoro-2-deoxy-D-glucose ( F-FDG) PET/CT for comparison.
F-FDGal PET/CT detected eight extrahepatic HCC metastases in six patients (12%), which were primarily not detected by ceCT or MRI. These findings led to a change in treatment in five patients (10%). One of the eight extrahepatic HCC foci was also detected by F-FDG PET/CT. A total of 85 malignant intrahepatic foci were examined, 12 of these were new findings by F-FDGal PET/CT which had a sensitivity of 71%, highest for large foci. None of the additional intrahepatic foci found by F-FDGal PET changed the planned treatment.
For the detection of extrahepatic HCC metastases, F-FDGal PET/CT was superior both to standard clinical work-up with contrast-enhanced CT, and/or MRI, and to F-FDG PET/CT in patients deemed suitable for locoregional treatment. F-FDGal PET/CT led to a change in the planned treatment in 10% of the patients whereas F-FDG PET/CT did not change the planned treatment in any patient.
使用肝脏特异性示踪剂[¹⁸F]-氟-2-脱氧-D-半乳糖（¹⁸F-FDGal）的正电子发射断层扫描（PET）可用于肝细胞癌（HCC）的成像。HCC的根治性和局部区域治疗需要无肝外疾病。这项前瞻性研究的目的是确定在标准检查中增加¹⁸F-FDGal PET/CT是否会改变被认为适合根治性或局部区域治疗的HCC患者的计划治疗方案。
我们的三级肝脏中心纳入了50例HCC患者。主要研究结果是治疗策略的改变。还对29例患者的亚组进行了[¹⁸F]-氟-2-脱氧-D-葡萄糖（¹⁸F-FDG）PET/CT检查以作比较。
¹⁸F-FDGal PET/CT在6例患者（12%）中检测到8个肝外HCC转移灶，这些转移灶主要未被增强CT或MRI检测到。这些发现导致5例患者（10%）的治疗发生改变。8个肝外HCC病灶中的1个也被¹⁸F-FDG PET/CT检测到。总共检查了85个肝内恶性病灶，其中12个是¹⁸F-FDGal PET/CT的新发现，其灵敏度为71%，对大病灶最高。¹⁸F-FDGal PET发现的额外肝内病灶均未改变计划治疗方案。
对于肝外HCC转移灶的检测，在被认为适合局部区域治疗的患者中，¹⁸F-FDGal PET/CT优于采用增强CT和/或MRI的标准临床检查，也优于¹⁸F-FDG PET/CT。¹⁸F-FDGal PET/CT导致10%的患者计划治疗方案发生改变，而¹⁸F-FDG PET/CT未使任何患者的计划治疗方案发生改变。
