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目的评价18F-FDG PET/CT对介入治疗后残留病灶的作用;分析碘油沉积状态和肿瘤残留灶的关系;探讨18F-FDG PET/CT的应用范围及在介入治疗中的价值。方法22例结节型或巨块型原发性肝癌患者(平均最大径8.1 cm),在动脉栓塞化疗(TACE)或动脉栓塞化疗序贯联合射频消融(RFA)治疗后行18F-FDG PET/CT检查。检查结果阳性者,分析残留灶和沉积碘油的关系,并在PET-CT指导下对其作进一步的介入治疗。检查结果阴性者,用影像学和血清AFP随访6个月,以判断是否为真阴性。结果全组有21例患者经介入治疗后病灶内有碘油沉积。其中3例TACE后的病灶在有无碘油沉积的部位均可见残留灶。18例TACE序贯RFA治疗的病例中有11例存在残留灶,其中9例位于碘油沉积区和非碘油沉积区;2例残留灶仅存在于非碘油沉积区;另外7例PET/CT显示阴性,但其中1例经随访证实为假阴性。按照PET/CT所示的残留灶作进一步的介入治疗,又有5例存在残留灶的患者达到了局部根治。结论18F-FDG PET/CT对大肝癌介入治疗后的残留病灶探测具有较高的灵敏度。介入治疗后的病灶,无论是碘油沉积区还是非碘油沉积区都可能有残留病灶存在。18F-FDG PET/CT可以用于介入治疗后的疗效评价,并能对进一步的介入治疗起到靶向指导作用。
Objective To evaluate the effect of 18F-FDG PET / CT on the residual lesions after interventional therapy. To analyze the relationship between the deposition state of lipiodol and residual tumor, and to explore the application of 18F-FDG PET / CT in interventional therapy. Methods Twenty-two patients with nodular or massive primary hepatocellular carcinoma (mean maximum diameter of 8.1 cm) were treated with 18F-FDG PET / CT after TACE or sequential radiofrequency catheter ablation (RFA) CT examination. The test results were positive, analysis of the relationship between residual foci and deposition of lipiodol, and under the guidance of PET-CT for further intervention. Negative results, with imaging and serum AFP were followed up for 6 months to determine whether the true negative. Results The whole group of 21 patients had lipiodol deposition in the lesion after interventional therapy. Three cases of TACE after the lesion in the presence or absence of lipiodol deposition can be seen at the site of residual foci. Eleven cases of residual TACE were found in 18 cases of TACE-sequential RFA, of which 9 cases were located in lipiod deposition and non-lipiod deposition areas, 2 cases only existed in non-lipiod deposition area, and 7 cases were PET / CT showed negative, but one of the follow-up confirmed as false negative. According to the PET / CT shown in the residual lesions for further interventional treatment, there are 5 cases of residual foci in patients with local radical. Conclusion 18F-FDG PET / CT has high sensitivity for the detection of residual lesions after the interventional treatment of large hepatocellular carcinoma. After interventional treatment of lesions, both the lipiodol deposition area or non-lipiod deposition area may have residual lesions exist. 18F-FDG PET / CT can be used for evaluating the curative effect after interventional therapy and can guide the further interventional therapy.