| Objective The results of 18F-FDG PET / CT scan and dynamic enhanced CT in 109 patients with clinical suspicious liver lesions were retrospectively analyzed, to compare the value of the two in diagnostic efficiency. To provide more objective information for clinical diagnosis and treatment.Materials and methods The images of FDG PET/CT and dynamic enhanced CT in 109 patients of suspected liver lesions were retrospectively analyzed, including 68 male patients, 41 female patients. The patients’ average age was(63.5 ±11.7), ranging from 39 ~ 92. Dynamic enhanced CT examination, after high-pressure syringe for intravenous injection of three phase dynamic contrast enhanced scan for liver, according to the lesion density, size, shape, position and three phase dynamic enhanced mode to determine the nature of the lesions. The 18F-FDG PET/CT images were analyzed semi-quantitatively and visually. Diagnosis of liver lesions were mainly based on the maximal standardized uptake value(SUVmax), position, morphological characteristics, tracer concertration features and lesion distribution, and medical history of the patient, etc.Final diagnosis of the patients were confirmed with histopathology or clinical follow-up. According to the type of the lesion, 109 primary liver cancer patients were divided into primary liver cancer group and hepatic metastasis group. The primary liver cancer group was divided into primary hepatocellular carcinoma group and benign liver tumor group. HCC group including hepatocellular carcinoma and cholangiocarcinoma. Compared the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of two methods in diagnosis of liver lesions. Results of the two groups were treated with χ2 test.Results 1. 49 patients who with primary liver lesions include hepatocellular carcinoma 29(59.1%, 29/49), intrahepatic cholangiocarcinoma 11(22.5%, 11/49) and hepatic benign tumor 9(18.4%, 9/49). The final diagnosis of liver metastases in 60 cases, 235 lesions, 140 lesions with diameter of ≥2cm, 95 lesions with diameter of 1cm~2cm. 30 primary liver tumors were corrected diagnosed by PET/CT, including hepatocellular carcinoma 15, intrahepatic cholangiocarcinoma 10, benign liver tumor 5; 36 primary hepatic tumors were corrected diagnosed by dynamic enhanced CT examination, including hepatocellular carcinoma 26, intrahepatic cholangiocarcinoma 6, benign liver tumor 4. 56 liver metastasis were found by PET/CT, 120 lesions with the diameter of ≥2cm, 84 lesions with diameter of <2cm;53 liver metastasis were found by dynamic enhanced CT, 122 lesions with diameter of ≥2cm, 73 lesions with diameter of <2cm.2. In primary liver cancer group, the sensitivity of PET/CT for liver hepatocellular carcinoma was 62.5%(25/40), the specificity was 55.6%, the accuracy was 61.2%(5/9)(30/49); the sensitivity of dynamic enhancement CT for primary liver carcinoma was 80%(32/40), the specificity was 44.4%(4/9), the accuracy was 73.5%(36/49), the difference between the two groups was not statistically significant.In 29 hepatocellular carcinoma, 15 were corrected diagnosed by PET/CT, including high-grade hepatocellular carcinoma 9, moderately differentiated hepatocellular carcinoma 5. The maximum diameter of the lesions ranged from 1.2cm to 17.8cm, SUVmax was 8.78 ± 5.15, the sensitivity of PET/CT in the diagnosis of hepatocellular carcinoma was 51.7%(15/29). PET/CT found 36 extrahepatic metastasis, including lung nodules 5, thoracic lymph nodes 5, abdominal lymph node 13, omentum and mesentery 6, spleen 1, adrenal gland 1, soft tissue 2, bone 3. 26 were correctd diagnosed by dynamic enhanced CT, 2 were false negative. The sensitivity of dynamic enhanced CT for hepatocellular carcinoma was 89.7%(26/29), higher than PET/CT, the difference of the two methods was statistically significant(χ2=10.07, P < 0.05).In 11 intrahepatic cholangiocarcinoma, 4 right lobe of liver lesions, 6 cases of left lobe of liver lesions. 10 were diagnosed by PET/CT correctly. The maximum diameter of the lesions ranged from 1.0cm to 13.5cm, SUVmax was 9.56±4.36. The sensitivity of PET/CT for intrahepatic cholangiocarcinoma was 90.9%(10/11). PET/CT found 17 extrahepatic metastasis, including lung nodules 2, thoracic lymph nodes 3, abdominal lymph node 6, omentum and mesentery 4, bone 2. 6 patients were correctly diagnosed by CT dynamic enhancement, the other 5 cases were diagnosed as benign lesions, the sensitivity of the dynamic enhancement CT for intrahepatic cholangiocarcinoma was 54.5%(6/11). The sensitivity of PET/CT for intrahepatic cholangiocarcinoma was higher than that of dynamic enhanced CT, because of the small number of cases, there was no significant difference between the two methods(χ2=3.67, P > 0.05).In the 9 patients with benign liver tumor,including tuberculosis 1, liver abscess 1, inflammatory myofibroblastic tumor 1, inflammatory pseudotumor of the liver 1, liver hemangioma 2, focal nodular hyperplasia(FNH) 1, cirrhosis of the liver 2. 5 were diagnosed by PET/CT correctly, 4 were diagnosed incorrectly. The sensitivity of PET/CT for hepatic benign tumor was 55.6%(5/9). 4 patients were correctlydiagnosed by dynamic enhancement CT, 5 were incorrectly diagnosed. The sensitivity of dynamic enhancement CT for the diagnosis of hepatic benign tumor was 44.4%(4/9 two), the difference of the two methods was not statistically significant(χ2=0.22, P > 0.05).3. The 60 liver metastatic tumor group were divided into two groups: 140 lesions with diameter of >2cm group, the liver metastasis detection rate of PET/CT was 85.7%(120/140), the sensitivity of the dynamic enhanced CT in the diagnosis of liver metastases was 87.1%(122/140), there was no significant difference(χ2=0.12, P > 0.05); 95 lesions with diameter of 1cm~2cm group, the liver metastasis detection rate of PET/CT was 88.4%(84/95), the sensitivity of dynamic enhanced CT in the diagnosis of liver metastases was 76.8%(73/95), there was significant difference between the two groups(χ2=4.44, P < 0.05). Liver metastasis of primary tumor were renal cell carcinoma 4, esophageal carcinoma 3, gastric cancer 8, gallbladder cancer4, lung cancer 5, pancreatic cancer 6, colorectal cancer 30. PET/CT found 40 primary liver cancer patients with a total of 53 extrahepatic metastasis, including lung nodules 7, thoracic lymph nodes 8, abdominal lymph node 19, omentum and mesentery 10, spleen 1, adrenal gland 2, bone 5 and soft tissue 2.Conclusions 1. The accuracy of judgments of hepatocellular carcinoma for PET/CT was associated with the degree of tumor differentiation, the judgment of poorly differentiated hepatocellular carcinoma for 18F-FDG PET/CT was poor. And in order to determine the nature of the lesions, we should analysis the lesions from all aspects, such as laboratory examination, clinical feature and the dynamic enhancement CT or other common imaging methods. The sensitivity of PET/CT for intrahepatic cholangiocarcinoma was higher than that of dynamic enhanced CT. The specificity of benign liver tumors by PET/CT was higher. The two examination methods should be used together, and improve the accuracy of judgment.The two methods can complement each other.2. The sensitivity of 18F-FDG PET/CT and dynamic enhanced CT for the hepatic metastases lesions with diameter of ≥2cm was similar. The sensitivity for the hepatic metastases lesions with diameter of 1 cm ~ 2 cm for PET/CT was higher.3. 18F-FDG PET/CT can evaluate primary lesions and metastases overally. PET/CThave some advantages in finding the extrahepatic metastases than dynamic enhanced CT. |
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