论文部分内容阅读
Objective: 18F-fluorodeoxyglucose (FDG) PET/CT alone has limited sensitivity for the diagnosis of liver carcinoma.We hope to improve the diagnostic accuracy by combining 18F-FDG and 11C-choline PET/CT.Methods: A total of 100 consecutive patients with suspicious liver masses were prospectively enrolled.Wholebody 18F-FDG PET/CT scan was performed on all patients.In those patients with negative 18F-FDG scans, a regional ~C-choline PET/CT scan was also performed.Results: Positive 18F-FDG scans were noted in 48 hepatocellular carcinoma (HCC), 9 cholangiocellular carcinoma (CCC), 1 chronic cholangitis and 1 fungal granuloma.Elevated serum α-fetoprotein levels, larger tumors, less differentiated tumors, multiple intrahepatic tumors and vascular invasion were significantly associated with positive 18F-FDG PET/CT results (P <0.01).In 43 patients with negative 18F-FDG scans, 1 1C-choline scan was positive in 20 patients with HCC and in 3 patients with focal nodular hyperplasia (FNH).Positive 11C-choline scans were not associated with Elevated serum AFP levels, tumor size and tumor number (P>0.05).11C-choline scan showed more sensitive for detection the HCC lesion <5.0cm (P=0.017) than 18F-FDG scan.Two modalities demonstrated no significant difference of detectability for HCCs with different tumor differentiation, increased a-fetoprotein level and tumor number (P>0.05).Hemangiomas in 12 patients was found to be 11C-choline defect and their SUVmax and T/L ratios were much lower compared to HCC (P < 0.001 and P =0.001).The dual modality approach improved the diagnostic sensitivity and accuracy from 67.0% to 90.5 %(P < 0.001) and 70.5% to 87.2% (P =0.006), while not decreasing the specificity (88.2% vs.70.5%, P=0.398).Wholebody 18F-FDG PET/CT detected the extrahepatic metastases with 85.0% sensitivity, 95.3% specificity and 92.9% accuracy, respectively.Conclusions: The addition of 11C-choline to 18F-FDG PET/CT increase the sensitivity in diagnosing primary and metastatic liver carcinoma, especially in primary HCC tumor <5.0cm.11C-choline PET/CT may play a potential role in differentiating HCCs from hemangiomas, but not in differentiating HCCs from FNH.