Evaluation Of¹⁸F-FDG PET/CT For Transarterial Chemolipiodolization Of Hepatocellular Carcinoma And The Prediction Of Treatment Response

Objective: Hepatocellular carcinoma is one of the most common malignant tumors inChina.In recent years,TACE has become the best choice for patients with liver cancerwho lose operation indication,and has been widely used in the treatment of livercancer.Previous studies have shown that hepatic carcinoma after TACE,tumor iodine oilaccumulation conditions, sedimentary formation and necrosis,tumor recurrence andpatients’ survival rate are closely related.At present, the routine CT and dynamicenhanced CT scanning is the most commonly used to evaluate tumor residual focalimaging methods, but the lesions after TACE often have a high density of lipiodoldeposition,because of the partial volume artifacts, effect of radiation artifacts anddifferent enhancement degree of tumor, the range of postoperative residual is difficult toaccurately identify radiation and tumor enhancement to different degrees, the range ofpostoperative residual is difficult to accurately identify.Magnetic resonance imaging（MRI） is another common imaging method with high resolution of softtissues,multiple sequence scanning.Foreign research shows that, MRI scanning ofprimary hepatocellular carcinoma after interventional therapy detection rate is superiorto CT scanning.MRI enhanced scan is a effective method used for screening of tumorrecurrence,but vulnerable to the interference of early postoperative inflammatoryresponse, thus affecting the curative effect evaluation. DSA is the gold standard in the detection of the presence of residual foci after TACE, but because it belongs to theinvasive and higher prices, not suitable for routine follow-up.In recent years, more and more domestic and foreign research focus on using¹⁸F-FDG PET-CT to evaluate the curative effect of TACE therapy and residual focalactivity.The purpose of this paper is to explore¹⁸F-FDG PET-CT evaluation of variationtrends of activity in the liver lesions for patients with primary liver cancer before andafter TACE and correlated with the prognosis of patients. In addition, the activity andthe change trend of lipiodol deposition and non-deposition area in hepatocellularcarcinoma after TACE is one of the purposes.Methods:Forward-looking selection in our department of interventional radiology, bothfor primary liver cancer of eligible patients, gather the basic laboratory and imagingexamination data（Mainly includes: the HBV and liver function, AFP, and clottingfunction, upper abdomen CT scan, etc.）Before TACE with conventional line¹⁸F-FDGPET-CT scan, scan before fasting6hours, peripheral blood glucose control in3.1-6.66mmol/L, intravenous injection of¹⁸F-FDG （0.1mCi/kg）, imaging agent injectionafter resting for1hour, after urination continuous800ml of drinking water scanningbed scanned on.Nuclear medical images and CT images collected automatically to theWizard’s workstation to image fusion.The two high qualification nuclear medicinephysician and a high qualification CT analysis of image and data preservation. AfterTACE,1-3month regular review,before line again with TACE.Collection in patientswith liver¹⁸F-FDG PET-CT data, evaluation of lesions iodine oildeposition and thechange of regional tumor activity and presence of new lesions, etc. Second¹⁸F-FDGPET-CT before and after a week adept liver CT scan and three phase dynamic enhancedscanning, and use the solid tumors RECIST criteria to evaluate tumor response withconventional therapy. With RECIST criteria judging tumor curative effect for reference,comparative analysis before and after TACE lesion size, numbers, port vein thrombos,the tendency of the tumor district SUV values and judgment of prognosis, latefor patients with long-term follow-up and to continue the evaluation of the situation tomake the right judgment.Results: Among the3SUV parameters,the area under the curve of Tsuvmax/Lsuvmaxwas the highest on the receiver-operating-characteristic curve.The Tsuvmax/Lsuvmaxwas used as the effectively parameter of¹⁸F-FDG PET in the prediction of response toHCC treatment.The cutoff value of Tsuvmax/Lsuvmax was3.72.Divided the patientsinto two groups according to the Tsuvmax/Lsuvmax cut-off value. Progression-freesurvival（PFS） time was estimated by the Kaplan-Meier method and the survivaldifference between groups was assessed by the log-rank test.Promt the FPS time ofgroup with lower Tsuvmax/Lsuvmax ratio was obviously longer than the group withhigh Tsuvmax/Lsuvmax ratio.The Tsuvmax/Lsuvmax ratio was compared with otherclinic factors that may affect the prognosis,including sex,age,AFP,tumor size andnumber,portal vein thrombosis and Child-Plugh. Continuous and categorical variableswere examined using Student t test and the chi-square test, respectively. Concluded thattumor size, portal vein thrombosis, Tsuvmax/Lsuvmax values associated with prognosis,P values were0.022,0.034,0.007,respectively. All variables found significant in theunivariate analysis were included in the multivariate model. The Cox proportionalhazards model was used for a multivariate analysis of survival. Factors associated withprognosis were portal vein thrombosis and Tsuvmax/Lsuvmax ratio, there aresignificant difference statistically significant.The tumors’ Tsuvmax/Lsuvmax ratio,T1suvmax/L’suvmax ratio of tumor with non lipiodol deposition after TACE andT2suvmax/L’suvmax ratio of tumor with lipiodol deposition density, paired ttest,average value of the three were3.3349±1.15112,2.5916±1.17979,1.6096±0.78747,analysis of the difference between the three was statistically significant hints, P＜0.01. Conclusion: TACE is an effective method of palliative treatment of livercancer.¹⁸F-FDG PET-CT is to assess the efficacy in the treatment of liver cancer is animportant and effective means. The ratio of Tsuvmax/Lsuvmax is the best indicator of¹⁸F-FDG PET-CT forecast parameters. The Tsuvmax/Lsuvmax value was predictive oftreatment effect and judgement is an important prognostic factor for survival, and theclinical treatment of liver cancer patients. TACE after the SUV ratio of the entire lesionthe operation is obviously reduced, and lipiodol deposition of dense regions than nonlipiodol deposition area more remarkable curative effect.TACE operation should bedeposited as far as possible so that the iodized oil more in tumor operation. If the initialTACE lipiodol deposition is poor, the best replacement or combined with othertreatment methods to prolong the survival time of patients.