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肝细胞肝癌(hepatocellular carcinoma,HCC)是全球第五大常见的肿瘤,患者病死数在肿瘤相关性病死数中居第二位[1]。我国是肝癌的高发国家,每年肝癌发病人数居世界第一[2]。目前,多种影像学方法(超声、CT、MRI和PET/CT等)已用于HCC的临床诊疗,其中,PET/CT是HCC诊断、分期和治疗决策制定的主要影像学技术之一,在HCC的诊疗路径中具有重要作用。18F-FDG是临床上最常用的PET/CT显像剂,在HCC的鉴别、手术和姑息性治疗中可提供有效的预后信息[3-6],Delbeke等[7]的研究结果显示,18F-FDG PET/CT对转移性肝癌的诊断灵敏度为96%,特异度为99%,但由于HCC的异质性明显,且肿瘤生物学特性复杂[8],18F-FDG PET/CT对HCC的诊断灵敏度仅为40%~60%[9-10]。有研究结果显示,随着HCC分化程度的不同,葡萄糖-6-磷酸酶的活性变化很大,高分化型HCC细胞在组织学上比中、低分化型HCC细胞更接近正常肝细胞[11],故葡萄糖-6-磷酸酶活性较强的肿瘤细胞无法被18F-FDG PET/CT检出。在低分化型HCC中,由于葡萄糖-6-磷酸酶的活性降低,18F-FDG滞留于肿瘤细胞内,致使其诊断率升高[12]。美国肝病协会指南提出,HCC的有效治疗依赖于早期诊断[13]。HCC的治疗方法包括手术切除、肝移植和小肿瘤的射频消融[14]。此外,有研究结果表明,早期HCC患者的5年生存率为40%~70%,而晚期HCC患者的5年生存率<5%[15]。基于以上原因,为使PET/CT在HCC诊断中发挥更大的作用,近几年,针对HCC的正电子示踪剂不断问世,特别是11C、18F和68Ga标记的化合物。
PET/CT在肝细胞肝癌中的应用现状
The application status of PET/CT in hepatocellular carcinoma
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摘要: 肝细胞肝癌(HCC)是全球癌症患者病死的主要原因之一。各种影像学技术为HCC的临床诊疗提供了重要信息。随着PET/CT在肿瘤学领域研究的不断进展,其在HCC的诊断、鉴别、精准分期以及局部残留和复发的评估方面起着至关重要的作用。双示踪技术已经成为辅助HCC诊断的重要技术,新型示踪剂的出现提高了PET/CT对HCC的诊断能力。笔者就目前PET/CT在HCC中的应用现状进行综述。
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关键词:
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 癌,肝细胞 /
- 放射性示踪剂
Abstract: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer mortality worldwide. Various imaging modalities provide important information about HCC for its clinical management. With the continuous progress of PET/CT research in oncology, it has played crucial roles in detecting, distinguishing, accurately staging, and evaluating local, residual and recurrent HCC. Dual tracer technology has become an important technology to assist HCC diagnosis, and the advent of new radiotracers has improved the ability to detect lesions. This paper reviews the current status of PET/CT for HCC. -
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