实用器官移植电子杂志

实用器官移植电子杂志 ›› 2020, Vol. 8 ›› Issue (5): 342-348.DOI: 10.3969/j.issn.2095-5332.2020.05.004

• 论著 • 上一篇    下一篇

18F-FDG PET/CT 代谢负荷参数在肝癌肝移植术前评估中的价值分析

丁恩慈，陆东燕，胡天鹏，孙茉茉，冯学民，沈婕
  

  1. 天津市第一中心医院核医学科，天津 300192
  • 出版日期:2020-09-20 发布日期:2021-05-06

The clinical value of 18F-FDG PET/CT metabolic parameters in the assessment of liver cancer prior to liver transplantation

Ding Enci，Lu Dongyan，Hu Tianpeng，Sun Momo，Feng Xuemin，Shen Jie.
  

  1. Department of Nuclear Medicine，Tianjin FirstCentral Hospital，Tianjin 300192，China.
  • Online:2020-09-20 Published:2021-05-06

PDF

摘要：

目的 旨在通过分析总结肝癌肝移植患者的临床病例特点及 PET/CT 代谢参数探讨 18 F-FDG PET/CT 在肝移植术前评估中的价值。方法 回顾性分析 2013 年 10 月—2017 年 5 月术前及术后均在天津市 第一中心医院行 18 F-FDG PET/CT 的肝癌肝移植患者共 96 例。用 TrueD 软件测量或计算正常肝实质、肝癌 病灶及纵隔的最大标准化摄取值 SUVmax（maximum standardized uptake value，SUV），病灶的瘦体标准摄取值 （SUV normalized to lean body mass，SUL），肿瘤代谢体积（metabolic tumor volume，MTV）、肿瘤 - 纵隔摄取 比（tumor-to-mediastinum SUV ratio，TMR）、肿瘤 - 正常肝摄取比（tumor-to-normal liver SUV ratio，TLR）、 糖酵解总量（total lesion glycolysis ，TLG）等代谢参数。代谢参数与临床因素的相关性分析及预测病理指标 的价值采用单因素方差分析（ANOVA），代谢参数之间的相关性分析计算 Pearson 相关系数。结果 患者中 90 例有肝炎病史，包括 83 例乙肝，5 例丙肝，1 例并发乙肝和丁肝，1 例自身免疫性肝炎。病理分化程度 ： 高、中、低分化分别为 28、36、22 例，2 例分化程度不清楚，4 例患肝未发现肿瘤。腔静脉、门静脉及胆 道残端及切缘阴性 90 例，阳性 2 例。卫星灶阴性 64 例，阳性 28 例。微血管侵犯阴性 51 例，阳性 41 例。 检出门脉及间质脉管瘤栓阴性患者 60 例，阳性 32 例。肝本底及纵隔血管本底 SUVmax（LBmax，Mmax）的 相关性为 0.867，肝组织本底高于纵隔本底。肿瘤代谢参数 SUVmax 及 SUL 的相关性为 0.985；瘤本比（TLR 及 TMR）的相关性为 0.986。不同 TNM 分期的代谢参数组间没有差异。病理类型肝细胞肝癌组及胆管细胞 癌组、中分化与低分化的病变代谢参数无显著差异。肿瘤数量、肿瘤部位、是否有肝硬化、肝炎类型及是 否活动、是否有癌栓、甲胎蛋白水平、静脉及胆道切缘是否阴性、是否有门脉及间质脉管瘤栓等与代谢参 数无显著差异。 淋巴结转移组与非转移组的 SUVmax、TMR、TLR、SUL、MTV、TLG 有显著差异（P ＜ 0.05）； 卫星灶阴性及卫星灶阳性组的 SUVmax、TMR、TLR 及 SUL 有显著差异（P ＜ 0.05），MTV 及 TLG 无显著 差异 ；微血管侵犯阴性及微血管侵犯阳性组的 TMR、TLR、SUL 及 TLG 有显著差异（P ＜ 0.05），不同组间 SUVmax 与 MTV 无显著差异。结论 18 F-FDG PET/CT 可以对患者的病情进行全面评价及准确分期，鉴别肿 瘤分化程度，预测血管侵犯，从而预测患者肝移植预后。

关键词:

Abstract:

Objective To explore the value of 18 F-FDG PET/CT in preoperative evaluation by analyzing the clinical characteristics and PET/CT metabolic parameters of liver transplantation patients with liver cancer. Methods A retrospective study from October 2014 to May 2017 was carried out, a total number of 92 patientswith liver cancer who received liver transplantation and had PET/CT examination pre and post operation in Tianjin First Central Hospital were enrolled. Metabolic parameters were measured or calculated using TrueD software including the maximum standardized uptake value（SUVmax）of normal liver parenchyma，liver cancer lesions and mediastinum，SUV normalized to lean body mass（SUL），tumor metabolic volume（MTV），tumor-to-mediastinum SUV ratio（TMR），tumor-tonormal liver SUV ratio（TLR）and total lesion glycolysis（TLG）. The correlation between metabolic parameters and clinical characteristics and their value in predicting pathological indicators were analyzed by one-way analysis of variance（ANOVA）， and the correlation between metabolic parameters was analyzed to calculate the Pearson correlation coefficient. Results A total number of 90 patients had a history of hepatitis，including 83 cases of hepatitis B，5 cases of hepatitis C， 1 case of hepatitis B and D，and 1 case of autoimmune hepatitis. The high，medium and low pathological differentiation cases were 28，36 and 22，respectively. Two cases with unclear differentiation and 4 cases had no tumor. There were 90 cases of negative stump or incisal edge of vena cava，portal vein and biliary system，and 2 cases were positive. A total number of 64 cases were negative for satellite nodules and 28 cases were positive. 51 cases were negative of microvascular invasion（MVI）and 41 cases were positive. A total number of 60 patients were negative of detected portal vein and interstitial vascular tumor embolus and 32 cases were positive. The correlation coefficient between the SUVmax of liver background and mediastinum background（LBmax，Mmax）was 0.867，and LBmax was higher than Mmax. The correlation coefficient between SUVmax and SUL was 0.985 and the correlation coefficient between TLR and TMR was 0.986. There was no difference between the metabolic parameters of different TNM stages. There was no significant difference between the metabolic parameters of hepatocellular carcinoma group and cholangiocarcinoma group，no difference was observed in moderately and poorly differentiated groups. There was no difference in the metabolic parameters when considering the tumor number，tumor site，cirrhosis，hepatitis type and activity，cancer thrombus，AFP level，negativity of stump or incisal edge of vena cava，portal vein and biliary，negativity of detected portal vein and interstitial vascular tumor embolus. There were significant differences in SUVmax，TMR，TLR，SUL，MTV and TLG between lymph node metastasis group and non-metastasis group（P ＜ 0.05）. There were significant differences in SUVmax，TMR，TLR and SUL and no significant differences in MTV and TLG between satellite nodules negative and positive groups（P ＜ 0.05）. There were significant differences in TMR，TLR，SUL and TLG between MVI negative and positive groups（P ＜ 0.05），and there was no significant difference in SUVmax and MTV between the two groups. Conclusion 18 F-FDG PET/CT can evaluate the tumor distribution and stage accurately and comprehensively，identify the degree of tumor differentiation，predict MVI，and so as to predict the prognosis of liver transplantation patients

Key words:

版权所有：实用器官移植电子杂志
本系统由北京玛格泰克科技发展有设计开发 技术支持：support@magtech.com.cn