- 期刊
Combining 11C-Acetate and 18F-FDG PET Studies: Experience in Patients with Hepatic Lesions
碳－11-Acetate和氟－18-FDG正子電腦斷層造影於肝臟病灶患者之應用
摘要
背景：健檢人士或癌症患者療後追蹤時，可能發現肝臟病灶。這些病灶的本質為何，以及病人應當如何處置，臨床上常引發高度關注。本研究旨在評估：對於這些患者合併使用碳－11-acetate和氟－18-FDG正子電腦斷層造影，是否具臨床助益。 方法：共15位肝臟局部病灶受檢者合併使用碳－11-acetate和氟－18-FDG正子電腦斷層造影，年齡層30至79歲，平均54歲。其中6例屬新發現肝臟病灶，9例屬癌症療後之追蹤（6例肝癌、1例膽管癌、1例大腸癌、1例膀胱癌）。影像採目視判讀。病人長期追蹤12個月以上，並參照其它影像檢查如電腦斷層攝影、核磁共振影像、超音波檢查或追蹤正子電腦斷層造影等，或經由手術取得病理診斷。對於每個異常病灶均計算其SUV值。 結果：有14位病人可確立診斷。對於新發現肝臟病灶之病患，碳－11-acetate和氟－18-FDG正子電腦斷層造影在1例肝細胞癌俱呈真陽性，在1例良性結節增生、1例血管瘤與1例脂肪浸潤俱呈真陰性。1例肝細胞癌無法由氟－18-FDG正子電腦斷層造影顯示異常放射活性，但可用碳－11-acetate偵測到。對於癌症療後追蹤之病患，碳－11-acetate和氟－18-FDG正子電腦斷層造影在2例肝細胞癌及1例膽管癌俱呈真陰性，在3例肝細胞癌及1例大腸癌併肝轉移俱呈偽陰性。另有2位肝細胞癌之病例，以氟－18-FDG正子電腦斷層造影可偵測出異常，但在碳－11-acetate正子電腦斷層造呈現偽陰性。二位其中之一合併肺轉移，其追蹤期間不滿6個月，於正子造影後3個月死亡。 結論：5位新近發現肝臟病灶之病患中，使用碳－11-acetate正子電腦斷層造影得以診斷1位以氟－18-FDG正子電腦斷層造影誤判為良性病灶的肝細胞癌病例。而在9位癌症療後追蹤之病患之中，有4位患者之存活腫瘤，無論使用碳－11-acetate或氟－18-FDG正子電腦斷層造影，都無法被偵測到。此外，有2位肝細胞癌病例，其病灶可由氟－18-FDG正子電腦斷層造影偵測到，但在碳－11-acetate正子電腦斷層造影卻呈偽陰性。
並列摘要
Background: Hepatic lesions may be found by conventional imaging tools in cases of cancer screening or for surveillance of treated cancers. Such hepatic lesions arouse much concern about the nature of disease and patient management. The aim of this study is to assess the possible benefit combing the use of 11C-acetate and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET). Methods: Fifteen patients with focal hepatic lesions (11 male, 4 female; age average 54 years, ranging from 30~79 years) were studied by both 11C-acetate and 18F-FDG PET scans. Among the 15 patients, 6 were aimed for cancer screening without previous cancer history and 9 for surveillance of treated cancers (7 hepatocellular carcinoma (HCC), 1 cholangiocarcinoma and 1 colon cancer). Images were analyzed by visual interpretation. Foci of abnormal radiotracer uptake were subsequently correlated with imaging modalities such as CT, MRI or repeated PET, pathology from surgical specimen and long-term follow-up for more than 12 months. Results: The results were available in 14 patients. In the subgroup of patients without cancer history, 11C-acetate and 18F-FDG PET were concordantly true positive in 1 case of HCC and true negative in 1 case of focal nodular hyperplasia, 1 case of hemangioma and another of fatty infiltration. One case of HCC, however, was missed by 18F-FDG PET but could be detected by 11C-acetate PET. In the subgroup of patients for surveillance of treated cancers, 11C-acetate and 18F-FDG PET were concordantly true negative in 2 cases of HCC and 1 case of cholangiocarcinoma, but both false negative in 3 cases of recurrent HCC and 1 case of colon cancer with liver metastasis. In addition, two patients with recurrent HCC detected by 18F-FDG PET were overlooked by C-acetate PET. One of the two cases had lung metastases and died within 3 months after PET studies. Conclusion: In this study, C-acetate PET detected one more case of HCC than 18F-FDG PET in five cases with newly discovered hepatic lesions. However, in cases of treated HCC or other cancers, considerable proportion (4/9) of cases, in the existence of viable tumors, could be neglected even by combining 11C-acetate and 18F-FDG PET. Furthermore, in two cases of recurrent HCC readily diagnosed by 18F-FDG PET, 11C-acetate PET was false-negative.