18F-FDG PET/CT显像在肝脏恶性肿瘤的初步应用

目的：评价^18F-FDGPET／CT对于肝脏恶性肿瘤的诊断、分期及疗效评判的价值。方法：对55例肝脏恶性肿瘤患者的PET／CT检查资料进行回顾性分析。原发性肝细胞性肝癌（PHC）11例，胆管细胞性肝癌1例，转移性肝癌40例，白血病肝浸润1例，淋巴瘤肝浸润2例。其中原发性肝癌经手术或穿刺证实，继发性肝脏恶性肿瘤均有明确肿瘤病史或临床检查随访证实。所有患者均行双时相全身PET／CT显像检查。结果：低分化PHC4例及胆管细胞癌1例，^18F—FDG异常高摄取，延迟后大部分病灶^18F—FDG摄取SUVmax上升；高分化原发性肝癌7例，其中^18F-FDG等摄取5例，相对肝本底为略低摄取2例；9例PHC及1例胆管细胞癌CT表现为低密度灶，2例PHC为等密度，7例患者有肝炎肝硬化基础，另外同时发现肝外病灶6例。继发性肝脏恶性肿瘤43例（含淋巴瘤、白血病肝浸润）中PET／CT上共发现109个病灶；其中99个肝内病灶表现为^18F-FDG高摄取，31个病灶CT未显示，另外有2例患者有4个病灶经手术证实有肝内微小病灶而PET／CT未检出；而淋巴瘤、白血病肝浸润表现为大片状或弥漫性^18F—FDG明显异常高摄取；大部分患者改变了原有的治疗方案。结论：^18F-FDGPET／CT在肝脏恶性肿瘤诊断、分期、评价分化程度及治疗方案的选择有较好的临床价值，PET／CT诊断肝脏恶性肿瘤明显优于单纯PET。充分认识PET／CT在肝脏恶性肿瘤中的应用价值及局限性，有利于临床对肝脏恶性肿瘤的诊治。

Clinical applications of 18F-FDG PET/CT in detecting hepatic malignant tumors

Objective:The objective of our study is to assess the roles of 18F-FDG PET/CT in the diagnosis,staging and monitoring response to therapy in hepatic malignant lesions.Methods:Imaging data of 55 patients with hepatic malignant lesions who had undergone whole-body 18F-FDG PET/CT were retrospectively reviewed.The study included 11 cases primary hepatio cellular(PHC),1 case with cholangiocellular carcinoma,40 cases with metastatic hepatic carcinoma(MHC),1 case with leukemia infiltration of liver and 2 cases with lymphoma infiltration of liver.Surgery,histopathology or follow-up imaging served as the standard of reference.Results:The lesons in 4 cases of poorly differentiated PHC and 1 case cholangiocellular carcinoma showed intense FDG uptake in 18F-FDG PET/CT scan,and increased uptake on delay PET/CT;The lesons in 7 cases of well differentiated PHC showed low uptake or uptake as normal liver 9 of PHC and cholangiocellular carcinoma CT finding showed low density,2 of them showed isodensity;7 of PHC were developed through malignant transformation of cirrhosis;Extrahepatic metastatic diseases were detected in 6 cases of PHC.The 99 of 109 lesions in 43 cases MHC(included leukemia or lymphoma infiltration of liver)showed intense FDG uptake;CT imaging showed 78 lesions,4 lesions of 2 cases in hepatic metastatic lesions confirmed by surgery showed nagative on PET/CT;In addition,leukemia or lymphoma infiltration of liver showed patches or diffuses intense FDG uptake.These diagnostic advantages resulted in the change of tumor staging and therapeutic planning in a substantial.Conclusion:PET/CT was an excellent modality in the diagnosis,staging,assessing the differentiation degree and monitoring treatment response of hepatic malignant lesions.It is illustrated that F-18 FDG PET/CT improves the diagnostic performance compared with PET alone.To achieve understanding of the application value and limitations with PET/CT fully is favour of clinically detecting the liver malignant tumour.