肝癌治疗后AFP增高患者的18F-FDGPET/CT与增强CT对照研究【摘要】目的:探讨18F-FDGPET/CT在监测肝细胞癌(HCC)治疗后AFP增高患者中肿瘤残余复发及肝外转移的临床价值,并比较18F-FDGPET/CT与增强CT(CECT)在肝内病灶的检出差异。方法:回顾性分析54例HCC治疗后AFP增高患者的18F-FDGPET/CT及CECT表现,两者的间隔时间≤2周。结果经病理或影像学、血清AFP水平监测等临床随访(>6个月)证实。结果:45例肝内残余复发,9例肝内未见残余复发;23例肝外转移,其中19例肝内残余复发并肝外转移,4例仅发现肝外转移。18F-FDGPET/CT及CECT对肝内病灶检出的灵敏度、特异度、准确性分别为88.9%(40/45)、57.8%(26/45),77.8%(7/9)、100%(9/9),87.0%(47/54)、64.8%(35/54),18F-FDGPET/CT灵敏度及准确性优于CECT(X2分别为12.621、8.205,P值均<0.01)。同时18F-FDGPET/CT对肝外转移病灶的灵敏度为100%(23/23)。结论:在HCC治疗后AFP增高患者中,18F-FDGPET/CT不但能早期诊断肝内肿瘤残余复发,并能有效地发现肝外转移;而且18F-FDGPET/CT对肝内病灶检出的灵敏度及准确性明显优于CECT。关键词:18F-FDG;PET/CT;治疗后;肝细胞癌;AFPComparedtheclinicalvalueof18F-FDGPET/CTwithCECTinhepatocellularcarcinomapatientsaftertherapywithserumAFPelevation【Abstract】Objective:Toassesstheclinicalusefulnessof18F-FDGindetectingoftumorresiduaorrecurrenceandmetastasisforpatientswithserumAFPelevationaftertherapyofhepatocellularcarcinoma(HCC).andComparethedifferencesofPET/CTandcontrastenhancedcomputedtomography(CECT)indetectingofliverlesion.MethodsThefindingof18F-FDGPET/CTandCECTin54HCCpatientswhichhadAFPelevationaftertherapywerestudiedretrospectively.Theresultswereconfirmedbypathologyorimagingfollow-upandthemonitoringofserumAFPlevelbyclinicalfollow-up(>6months).Results:45patientshavebeendiagnosedwithHCCfocalsurvival,recurrenceaftertreatment.ninepatientsdidnotdevelopHCCfocalsurvivalorrecurrence.23patientsdevelopedextrahepaticmetastasis.19patientsdevelopedextrahepaticmetastasisassociatedwithfocalsurvivalorrecurrence.Fourpatientsonlydevelopedextrahepaticmetastasis.Thesensitivity,specificity,accuracyof18F-FDGPET/CTforliverlesioninthedetectionofHCCrecurrencewere88.9%(40/45)、77.8%(7/9),87.0%(47/54)respectively.InCECT,thecorrespondingvalueswere57.8%(26/45)、100%(9/9)、64.8%(35/54).Therefore,thesensitivityandaccuracyof18F-FDGPET/CTissignificantlyhigherthanthatofCECT.Conclusion:18F-PET/CThasahighsensitivityandaccuracycomparingwithCECTindetectingthelocaltumorresiduaorrecurrenofHCCintheintheliveraftertherapy.Itisausefulimagingmodalitynotonlyfordetectingoftumorresiduaorrecurrentwithliverearly,butalsofordiscoveringofextrahepaticlesionseffectively.KEYWORDS:PET/CT;18F-FDG;recurrence;hepatocellularcarcinoma;post-therapeutic肝细胞癌(hepatpcellularcarcinomaHCC)是我国常见的恶性肿瘤之一。目前,手术切除是HCC治疗的首选方法,但只有大约40%的患者可从手术治疗中获益,大部分患者需接受各种非手术治疗。但HCC治疗后都存在着较高的复发及转移率,使治疗后远期疗效不理想。因此,HCC治疗后早期诊断肿瘤残余、复发或转移对于进一步治疗及延长生存期至关重要。目前,常规影像学检查及AFP检查在这方面仍存在着一些不足,而18F-FDGPET/CT有望发挥更大的作用。本研究回顾性分析了54例HCC治疗后AFP增高患者的临床及影像学资料,结合文献分析,初步评价了18F-FDGPET/CT及增高CT(contrastenhancedcomputedtomographyCECT)在HCC治疗后肿瘤残余复发及转移中的临床价值及其局限性。1.材料与方法1.1临床资料54例HCC治疗后AFP增高患者,临床和病理资料完整。男性32例,女性2例,年龄34~83(52±12)岁。均为临床随访中AFP升高或进行性升高(22~43662ug/l,平均353...