CAJ | 학술논문

目的探讨PET-CT在甲胎蛋白(AFP)阳性肝细胞癌介入术后监测碘油沉积区内残留病灶及肝外转移病灶的价值.方法选取20例经病理组织学确诊的原发性肝细胞癌患者,在介入治疗后AFP降至正常,随访发现AFP异常升高,常规行上腹部CT、MR检查未能明确碘油沉积区内残留病灶及肝外转移病灶或发现可疑影像学表现但不能确定其性质者行PET-CT扫描,依据PET-CT的结果进一步治疗,并用影像检查及AFP检查监测其治疗效果.结果 20例患者中,常规上腹部影像检查未发现肝外转移病灶而经PET-CT检出者10例,包括邻近腹壁转移4例,肺内直径约1 cm的孤立转移3例,肠系膜转移2例,手术切口转移1例;CT或MRI发现原碘油沉积区内有碘油沉积不均匀区域,但运用包括血管造影在内的检查方法均不能确定其是否为残留病灶而经PET-CT确诊者8例;CT扫描发现肝门区及腹膜后直径<1.5 cm的淋巴结但不能明确是否为淋巴结转移,经PET-CT明确者2例.采用外科手术及介入方法对检出病灶进一步治疗,除2例淋巴结转移患者AFP仍略高于正常外,其余患者AFP均逐渐降至正常,影像检查亦提示病灶治疗效果良好.结论 PET-CT对于AFP水平异常升高而常规影像检查未能发现碘油沉积区残留病灶及肝外转移病灶或无法确定可疑影像表现性质的肝细胞癌患者是一种有效的检查方法.
목적 탐토PET-CT재갑태단백(AFP)양성간세포암개입술후감측전유침적구내잔류병조급간외전이병조적개치.방법 선취20례경병리조직학학진적원발성간세포암환자,재개입치료후AFP강지정상,수방발현AFP이상승고,상규행상복부CT、MR검사미능명학전유침적구내잔류병조급간외전이병조혹발현가의영상학표현단불능학정기성질자행PET-CT소묘,의거PET-CT적결과진일보치료,병용영상검사급AFP검사감측기치료효과.결과 20례환자중,상규상복부영상검사미발현간외전이병조이경PET-CT검출자10례,포괄린근복벽전이4례,폐내직경약1 cm적고립전이3례,장계막전이2례,수술절구전이1례;CT혹MRI발현원전유침적구내유전유침적불균균구역,단운용포괄혈관조영재내적검사방법균불능학정기시부위잔류병조이경PET-CT학진자8례;CT소묘발현간문구급복막후직경<1.5 cm적림파결단불능명학시부위림파결전이,경PET-CT명학자2례.채용외과수술급개입방법대검출병조진일보치료,제2례림파결전이환자AFP잉략고우정상외,기여환자AFP균축점강지정상,영상검사역제시병조치료효과량호.결론 PET-CT대우AFP수평이상승고이상규영상검사미능발현전유침적구잔류병조급간외전이병조혹무법학정가의영상표현성질적간세포암환자시일충유효적검사방법.
Objective To investigate the value of positron emisson tomography-computed tomography ( PET-CT) in monitoring the residual lesions in lipiodol sedimentary region and extrahepatic metastastic lesions of hepatocellular carcinoma ( HCC) with alpha fetoproteins ( AFP) positive after interventional therapy. Methods The data of 20 cases with primary HCC confirmed by histopathology were retrospectively analyzed. Their AFP levels decreased to normal range after interventional treatments, but rose to abnormal high level during following-up. After the abdominal routine imaging examinations, the definite diagnosis of the residual lesions in lipiodol sedimentary region or extrahepatic lesions can't be made confidently. All cases were scanned by PET-CT, and according to their PET-CT results, the further treatments were given and the therapeutic results were monitored with radiology and AFP tests. Results In all 20 cases, 10 of them were detected to have the extrahepatic metastastic lesions by PET-CT, including 4 with abdominal wall metastasis upon the liver, 3 with solitary pulmonary metastasis with diameter less than 1 cm, 2 with mesenteric mestastasis, 1 with mestastasis of operative incisions, but these lesions were neglected by abdominal routine imaging examinations. Eight cases showed the uneven lipiodol sedimentary region in the primary lesion by CT or MRI examination, but can't be diagnosed whether it was residual lesion with other examinations including DSA. A definite diagnosis was obtained by PET-CT. In 2 cases, lymph nodes less than 1. 5 cm were found in the hepatic portal area(PHA) and retroperitoneum on CT images,which was determined to be metastatic by PET-CT. All the detected lesions were given further treatments of surgery or interventional therapy. Most patients showed decreased AFP levels except the 2 patients with lymph node metastasis. The imaging examinations also indicated that the treatments had a good effect on lesions. Conclusion In the patients with HCC and abnormal high levels of AFP, in addition to abdominal routine imaging examinations, PET-CT is beneficial for those who is suspected of residual lesions in lipiodol sedimentary region or extrahepatic metastasis.