CAJ | 학술논문

目的：探讨18F-脱氧葡萄糖（FDG）PET/CT显像在肝细胞癌（HCC）经导管肝动脉化疗栓塞术（TACE）后残留病灶的诊断和预后判断中的价值。方法回顾性分析73例HCC患者TACE后行18F-FDG PET/CT检查，以临床随访及病理结果为标准进行对照分析。根据TA C E术后碘油在肝癌病灶中沉积面积的大小分为3型。Ⅰ型：碘油沉积面积>60%的病灶面积；Ⅱ型：碘油沉积面积占病灶面积的20%~60%；Ⅲ型：碘油沉积面积<20%的病灶面积。18F-FDG PET/CT诊断残留病灶的效能与增强CT（CECT）进行对比分析，并进一步探讨肿瘤最大标准摄取值与正常肝组织平均标准摄取值的比值（TSUVmax/LSUVmean）与生存预后的关系。结果比较受试者工作特征曲线（ROC）曲线下面积显示，18F-FDG PET/CT显像在HCC患者TACE术后残留病灶检测中的价值显著优于CECT（P=0.04）。TSUVmax/LSUVmean≥1.65与肿瘤大小（P=0.0096）、碘油沉积面积（P=0.0387）、血清甲胎蛋白（AFP）水平（P=0.0142）显著相关，但与肿瘤病理分级无明显相关性（P=0.2626）。TSUVmax/LSUVmean<1.65组患者的总生存率显著增高（P=0.024）。结论18F-FDG PET/CT显像在HCC患者TACE术后残留活性病灶的检测中有较高的诊断效能，且真实性和可靠性良好，明显优于增强CT；同时TSUVmax/LSUVmean可作为TACE治疗后患者生存预后的独立预测因子，对协助临床确定个体化治疗方案具有重要价值。
목적：탐토18F-탈양포도당（FDG）PET/CT현상재간세포암（HCC）경도관간동맥화료전새술（TACE）후잔류병조적진단화예후판단중적개치。방법회고성분석73례HCC환자TACE후행18F-FDG PET/CT검사，이림상수방급병리결과위표준진행대조분석。근거TA C E술후전유재간암병조중침적면적적대소분위3형。Ⅰ형：전유침적면적>60%적병조면적；Ⅱ형：전유침적면적점병조면적적20%~60%；Ⅲ형：전유침적면적<20%적병조면적。18F-FDG PET/CT진단잔류병조적효능여증강CT（CECT）진행대비분석，병진일보탐토종류최대표준섭취치여정상간조직평균표준섭취치적비치（TSUVmax/LSUVmean）여생존예후적관계。결과비교수시자공작특정곡선（ROC）곡선하면적현시，18F-FDG PET/CT현상재HCC환자TACE술후잔류병조검측중적개치현저우우CECT（P=0.04）。TSUVmax/LSUVmean≥1.65여종류대소（P=0.0096）、전유침적면적（P=0.0387）、혈청갑태단백（AFP）수평（P=0.0142）현저상관，단여종류병리분급무명현상관성（P=0.2626）。TSUVmax/LSUVmean<1.65조환자적총생존솔현저증고（P=0.024）。결론18F-FDG PET/CT현상재HCC환자TACE술후잔류활성병조적검측중유교고적진단효능，차진실성화가고성량호，명현우우증강CT；동시TSUVmax/LSUVmean가작위TACE치료후환자생존예후적독립예측인자，대협조림상학정개체화치료방안구유중요개치。
Objective To evaluate the efficacy of 18F-fluorodeoxyglucose(18F-FDG) PET/CT in detecting viable tumor and predicting prognosis of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) treatment. Methods A total of 73 patients with 91 HCCs who had undergone TACE with lipiodol before 18F-FDG PET/CT were retrospectively analyzed. The pattern of lipiodol deposition in the tumor was divided into three grades: Grade I, the area of lipiodol remaining over 60% of the tumor; Grade Ⅱ, 20%-60%; Grade Ⅲ, less than 20%. The performance of 18F-FDG PET/CT in evaluating the viability of HCC was assessed and compared with that of contrast-enhanced CT (CECT). The predictive value of maximal tumor standardized uptake value (SUV) to mean liver SUV (TSUVmax/LSUVmean) ratio was tested. Results By comparing the area under the receiver operating characteristic curve 18F-FDG-PET/CT was found to be superior to CECT for the detection of viable tumor in patients with HCC after TACE (P=0.04). A high SUV ratio (TSUVmax/LSUVmean≥1.65) was correlated significantly with tumor size (P=0.009 6), grade of lipiodol deposition (P=0.038 7) and serum α-fetoprotein(AFP) level (P=0.014 2), but not correlated with pathologic grade (P=0.262 6). Overall survival rate was significantly higher in low SUV ratio (TSUVmax/LSUVmean<1.65) group (P=0.024). Conclusion 18F-FDG-PET/CT is efficient in assessing the viability of HCC after TACE treatment and superior to CECT. It can provide valuable information for prediction of prognosis and treatment strategy.