Department of Radiology, APHP, Hôpitaux Universitaires Henri Mondor, 51 Ave du Marechal de Lattre de Tassigny, 94010 Créteil, France.
Department of Nuclear Medicine, APHP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
AJR Am J Roentgenol. 2022 Feb;218(2):359-369. doi: 10.2214/AJR.21.26485. Epub 2021 Sep 8.
. Assessment of hepatocellular carcinoma (HCC) treatment response after transarterial radioembolization (TARE) is challenging, because response by conventional imaging criteria may not become apparent until 6 months after treatment. Though HCC exhibits variable avidity for FDG, some cases of HCC without avidity for FDG show avidity for F-fluorocholine (F-FCH). . The purpose of this study was to evaluate the utility of early posttreatment evaluation by PET/CT using FDG or F-FCH to predict 6-month treatment response and survival after TARE in patients with HCC. . This retrospective study included 37 patients (mean age, 67 years; 34 men, three women) with documented HCC treated by TARE who underwent both pre-treatment FDG PET/CT and F-FCH PET/CT and early FDG PET/CT and/or F-FCH PET/CT 4-8 weeks after treatment; FDG PET/CT and F-FCH PET/CT examinations were performed on separate dates. Only one of 73 initially identified potentially eligible patients was excluded because of lack of HCC avidity for both FDG and F-FCH. Response assessment by modified RECIST (mRECIST) on multiphase CT or MRI was performed at 1 month and 6 months in 23 patients. Early responses seen on PET/CT and 1-month mRECIST response were assessed as predictors of 6-month mRECIST response. Univariable and multivariable predictors of overall survival (OS) were identified. . On pretreatment PET/CT, 28 (76%) patients were FDG-positive (showed visual uptake on FDG PET/CT and tumor-to-normal liver ratio > 1.15), 15 (41%) were FCH-positive (showed visual uptake on F-FCH PET/CT), and six (16%) were both FDG-positive and FCH-positive. Twelve of 28 FDG-positive HCCs exhibited early response by FDG PET/CT; seven of 15 FCH-positive HCCs exhibited early response by F-FCH PET/CT. Twelve (52%) patients exhibited 6-month mRECIST response. Response seen on early posttreatment PET/CT exhibited 100% (12/12) sensitivity and 100% (11/11) specificity for 6-month mRECIST response, whereas 1-month mRECIST response exhibited 67% (8/12) sensitivity and 100% (11/11) specificity for 6-month mRECIST response. Response seen on early posttreatment PET/CT was a significant independent predictor of OS on univariable (hazard ratio [HR], 0.4; 95% CI, 0.2-0.9; = .03) and multivariable (HR, 0.2; 95% CI, 0.1-0.8; = .01) analyses. . Early evaluation after TARE by PET/CT using FDG or F-FCH may pre dict 6-month response and OS in patients with HCC. . Early posttreatment evaluation with PET/CT could help more reliably identify true nonresponders after TARE, which in turn could prompt early response-adapted therapeutic management.
. 经动脉放射性栓塞术（TARE）后评估肝细胞癌（HCC）的治疗反应具有挑战性，因为常规影像学标准的反应可能要在治疗后 6 个月才变得明显。尽管 HCC 对 FDG 具有不同的摄取能力，但一些无 FDG 摄取能力的 HCC 对 F-氟胆碱（F-FCH）具有摄取能力。. 本研究旨在评估 FDG 或 F-FCH 治疗后早期 PET/CT 评估对 TARE 后 6 个月治疗反应和生存的预测价值。. 这项回顾性研究纳入了 37 名经 TARE 治疗的 HCC 患者（平均年龄 67 岁；34 名男性，3 名女性），这些患者在治疗前均接受了 FDG PET/CT 和 F-FCH PET/CT 检查，并在治疗后 4-8 周接受了早期 FDG PET/CT 和/或 F-FCH PET/CT 检查；FDG PET/CT 和 F-FCH PET/CT 检查在不同日期进行。最初确定的 73 名潜在合格患者中，只有 1 名因 FDG 和 F-FCH 均无 HCC 摄取而被排除。23 名患者在 1 个月和 6 个月时通过多期 CT 或 MRI 进行了改良 RECIST（mRECIST）评估。PET/CT 和 1 个月 mRECIST 反应的早期反应被评估为 6 个月 mRECIST 反应的预测因素。确定了总生存（OS）的单变量和多变量预测因素。. 在治疗前的 PET/CT 上，28 名（76%）患者为 FDG 阳性（FDG PET/CT 上显示可见摄取，肿瘤与正常肝脏比值＞1.15），15 名（41%）为 FCH 阳性（F-FCH PET/CT 上显示可见摄取），6 名（16%）为 FDG 和 FCH 均阳性。28 名 FDG 阳性 HCC 中有 12 名在 FDG PET/CT 上显示早期反应；15 名 FCH 阳性 HCC 中有 7 名在 F-FCH PET/CT 上显示早期反应。12 名（52%）患者在 6 个月时达到 mRECIST 反应。早期治疗后 PET/CT 上的反应对 6 个月 mRECIST 反应的敏感性为 100%（12/12），特异性为 100%（11/11），而 1 个月 mRECIST 反应的敏感性为 67%（8/12），特异性为 100%（11/11）。早期治疗后 PET/CT 上的反应是 OS 的独立预测因素（危险比[HR]，0.4；95%CI，0.2-0.9；=.03）和多变量（HR，0.2；95%CI，0.1-0.8；=.01）分析。. TARE 后使用 FDG 或 F-FCH 的 PET/CT 早期评估可能可以预测 HCC 患者 6 个月的反应和 OS。. TARE 后使用 PET/CT 的早期治疗评估可以帮助更可靠地识别 TARE 后的真正无反应者，从而可以促使早期进行反应适应的治疗管理。
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