Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Nuclear Medicine, Zhongshan Hospital（Xiamen), Fudan University, Xiamen, Fujian, China.
Abdom Radiol (NY). 2023 Oct;48(10):3127-3134. doi: 10.1007/s00261-023-03986-y. Epub 2023 Jul 13.
To investigate the diagnostic value of early dynamic F-FDG PET/CT(ED F-FDG PET/CT) combined with conventional whole-body F-FDG PET/CT(WB F-FDG PET/CT) in hepatocellular carcinoma (HCC), as well as the difference of early dynamic blood flow parameters and maximum standardized uptake value (SUVmax) in HCC patients with/without liver cirrhosis or microvascular invasion (MVI).
Twenty-two consecutive patients (mean age 57.8 years) with 28 established HCC lesions (mean size 4.5 cm) underwent a blood flow study with an F-FDG dynamic scan divided into 24 sequences of 5 s each and a standard PET/CT scan. On the ED PET/CT study, an experienced PET/CT physician obtained volumes of interest (VOIs) where three blood flow estimates (time to peak [TTP], blood flow [BF], and hepatic perfusion index [HPI]) were calculated. On the WB PET/CT study, a VOI was placed on the fused scan for each HCC and maximum standardized uptake value (SUVmax) was obtained. Comparison of blood flow estimates, SUVmax, and tumor/background ratio (TNR) was performed among HCCs with and without angioinvasion, as well as HCCs in cirrhotic and non-cirrhotic liver.
Compared with WB F-FDG PET/CT alone, ED combined with WB F-FDG PET/CT can significantly increase the detection rate of moderately differentiated and poorly differentiated HCCs (both P < 0.05). HPI was higher in HCCs in patients with liver cirrhosis than those without liver cirrhosis (P = 0.044). There was no significant difference in TTP, BF, SUVmax, or TNR between HCCs in patients with liver cirrhosis and those without liver cirrhosis. There was no significant difference in blood flow estimates or SUVmax in background liver parenchyma between patients with and those without cirrhosis. TTP was shorter in HCCs with MVI than without MVI (P = 0.046). There was no significant difference in BF, HPI, SUVmax, or TNR between HCCs with MVI and without MVI. There was no significant difference in blood flow estimates or SUVmax in background liver parenchyma between patients with and those without MVI.
ED combined with WB F-FDG PET/CT can significantly increase the detection rate of moderately differentiated and poorly differentiated HCCs. HPI was significantly higher in HCCs in patients with liver cirrhosis than those without liver cirrhosis. TTP was significantly shorter in HCCs with MVI than without MVI.
探讨早期动态 F-FDG PET/CT（ED F-FDG PET/CT）联合常规全身 F-FDG PET/CT（WB F-FDG PET/CT）对肝细胞癌（HCC）的诊断价值，以及肝硬化或微血管侵犯（MVI）患者 HCC 之间早期血流动力学参数和最大标准化摄取值（SUVmax）的差异。
22 例连续患者（平均年龄 57.8 岁）共 28 个已确诊 HCC 病变（平均大小 4.5cm）接受 F-FDG 动态扫描血流研究，共 24 个 5s 序列，并进行标准 PET/CT 扫描。在 ED PET/CT 研究中，一位经验丰富的 PET/CT 医师获得了三个血流估计值（达峰时间[TTP]、血流[BF]和肝灌注指数[HPI]）的感兴趣区（VOI）。在 WB PET/CT 研究中，在融合扫描上为每个 HCC 放置了一个 VOI，并获得了最大标准化摄取值（SUVmax）。比较了有和无血管侵犯的 HCC 之间、肝硬化和非肝硬化肝之间的血流估计值、SUVmax 和肿瘤/背景比（TNR）。
与单独的 WB F-FDG PET/CT 相比，ED 联合 WB F-FDG PET/CT 可显著提高中、低分化 HCC 的检出率（均 P<0.05）。肝硬化患者 HCC 的 HPI 高于非肝硬化患者（P=0.044）。肝硬化患者与非肝硬化患者 HCC 的 TTP、BF、SUVmax 或 TNR 无显著差异。肝硬化患者与非肝硬化患者背景肝实质的血流估计值或 SUVmax 无显著差异。MVI 患者 HCC 的 TTP 短于无 MVI 患者（P=0.046）。有 MVI 和无 MVI 的 HCC 之间的 BF、HPI、SUVmax 或 TNR 无显著差异。有 MVI 和无 MVI 的患者背景肝实质的血流估计值或 SUVmax 无显著差异。
ED 联合 WB F-FDG PET/CT 可显著提高中、低分化 HCC 的检出率。肝硬化患者 HCC 的 HPI 明显高于非肝硬化患者。有 MVI 的 HCC 的 TTP 明显短于无 MVI 的 HCC。
