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Chen D, Chang C, Zhang Y, Yang S, Wang G, Lin L, Zhao X, Zhao K, Su X. Different Features of 18F-FAPI, 18F-FDG PET/CT and MRI in the Evaluation of Extrahepatic Metastases and Local Recurrent Hepatocellular Carcinoma (HCC): A Case Report and Review of the Literature. Cancer Manag Res 2022; 14:2649-2655. [PMID: 36090470 PMCID: PMC9462837 DOI: 10.2147/cmar.s374916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Recurrence and metastasis are important causes of postoperative death in most HCC patients. Conventional imaging modalities such as 18F-FDG PET/CT and enhanced MRI are still unsatisfactory in evaluating these patients in the clinical setting. PET/CT imaging with a radiolabeled fibroblast activation protein inhibitor (FAPI) has emerged as a new imaging technique for the diagnosis and radiotherapy of malignant tumors. While many studies have focused on the diagnostic accuracy of intrahepatic primary HCC, the evaluation of recurrent and metastatic HCC remains only poorly investigated. Case Presentation A 71-year-old man with a five-year history of HCC after radical resection underwent 18F-FDG PET/CT due to further surgery for tumor recurrence, which revealed two iso-metabolic lesions in the right peritoneum and a hypo-metabolic lesion in the right liver. 18F-FAPI PET/CT was performed to further complement 18F-FDG PET/CT in the detection of these suspected metastatic lesions. Importantly, multiple diffuse intense radioactivity was shown in the hepatic capsule, suggesting metastatic lesions, but a wedge-shaped elevated 18F-FAPI uptake disorder around the FDG-unavid necrotic lesion after radiofrequency ablation (RFA) demonstrated benign stromal fibrosis. Conclusion This case suggested that 18F-FAPI may have an advantage over 18F-FDG in detecting peritoneal metastasis even in tiny or early hepatic capsules of HCC, but its false positives due to postoperative stromal fibrosis should be noted. Wedge- or strip-shaped FAPI-avid lesions with sharp edges may be post-treatment stromal fibrosis.
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Affiliation(s)
- Donghe Chen
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Chengdong Chang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yafei Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shuye Yang
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Guolin Wang
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Lili Lin
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xin Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Kui Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xinhui Su
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Prognostic Value of Metabolic Imaging Data of 11C-choline PET/CT in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13030472. [PMID: 33530520 PMCID: PMC7865313 DOI: 10.3390/cancers13030472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Few data are available for the use of 11C-choline positron emission tomography/computed tomography (PET/CT) in patients with hepatocellular carcinoma (HCC). The aim of the study was to analyze the clinical impact of this metabolic imaging in patients with HCC candidates for hepatectomy. Seven parameters were recorded for PET/CT in 60 patients. The Cox regression for overall survival (OS) showed that Barcelona stages (p = 0.003) and metabolic tumor volume (MTV) (p = 0.026) were the only factors independently associated with OS and furthermore, curve analysis revealed MTV ability in predicting OS. Patients with MTV ≥ 380 had worse OS (p = 0.015). The use of 11C-choline PET/CT allows for better prognostic refinement in patients undergoing hepatectomy for HCC: integration of such metabolic modality into HCC staging system should be considered. Abstract 11C-choline positron emission tomography/computed tomography (PET/CT) has been used for patients with some types of tumors, but few data are available for hepatocellular carcinoma (HCC). We queried our prospective database for patients with HCC staged with 11C-choline PET/CT to assess the clinical impact of this imaging modality. Seven parameters were recorded: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), liver standardized uptake value (SUVliver), metabolic tumor volume (MTV), photopenic area, metabolic tumor burden (MTB = MTVxSUVmean), and SUVratio (SUVmax/SUVliver). Analysis was performed to identify parameters that could be predictors of overall survival (OS). Sixty patients were analyzed: fourteen (23%) were in stage 0-A, 37 (62%) in stage B, and 9 (15%) in stage C of the Barcelona classification. The Cox regression for OS showed that Barcelona stages (HR = 2.94; 95%CI = 1.41–4.51; p = 0.003) and MTV (HR = 2.11; 95%CI = 1.51–3.45; p = 0.026) were the only factors independently associated with OS. Receiver operating characteristics curve analysis revealed MTV ability in discriminating survival (area under the curve (AUC) = 0.77; 95%CI = 0.57–097; p < 0.001: patients with MTV ≥ 380 had worse OS (p = 0.015)). The use of 11C-choline PET/CT allows for better prognostic refinement in patients undergoing hepatectomy for HCC. Incorporation of such modality into HCC staging system should be considered.
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Alotaibi F, Kabbani M, Abaalkhail F, Chorley A, Elbeshbeshy H, Al-Hamoudi W, Alabbad S, Boehnert MU, Alsofayan M, Al-Kattan W, Ahmed B, Broering D, Al Sebayel M, Elsiesy H. Low Utility of Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography for Detecting Hepatocellular Carcinoma in Patients Before Liver Transplantation. EXP CLIN TRANSPLANT 2017; 15:37-41. [PMID: 28260429 DOI: 10.6002/ect.mesot2016.o21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our program routinely used fluorodeoxyglucose-positron emission tomography/computed tomography as part of the liver transplant evaluation of patients with hepatocellular carcinoma. The aim of this study was to evaluate the role of this imaging modality in the pretransplant work-up. MATERIALS AND METHODS This was a retrospective chart review of our liver transplant database from January 2011 to December 2014 for all patients with hepatocellular carcinoma who underwent a liver transplant. Collected data included age, sex, cause of liver disease, imaging modality, fluorodeoxyglucose-positron emission tomography/computed tomography results, explant tissue analysis, type of transplant, and transplant outcome. RESULTS During the study period, 275 liver transplants were performed. Fifty-three patients had hepatocellular carcinoma; 41 underwent fluorodeoxyglucose-positron emission tomography/computed tomography. Twenty-nine patients underwent living-donor liver transplant, and 12 patients underwent deceased-donor liver transplant. One of the 41 patients with negative FDG-imaging results had no evidence of hepatocellular carcinoma in the explant and was excluded from the study. The patients' average age was 58 years (range, 22-72 y), and 28 patients were men. The cause of liver disease was hepatitis C virus in 24 patients, cryptogenic cirrhosis in 12 patients, and hepatitis B virus in 5 patients. One patient had no hepatocellular carcinoma on explants and was excluded from the study. Twenty-five patients had hepatocellular carcinoma that met the Milan criteria, 7 were within the UCSF (University of California, San Francisco) criteria, and 8 exceeded the UCSF criteria. Of the 40 patients, 11 had positive fluorodeoxyglucose-positron emission tomography/computed tomography results (27.5%) with evidence of hepatocellular carcinoma in the explant; the remaining 29 patients (72.5%) had negative results. The fluorodeoxyglucose-positron emission tomography/computed tomography results were positive in 16% (4 of 21) of patients who met the Milan criteria, 28% (2 of 7) of patients who met the UCSF criteria and 62% (5 of 8) of patients who exceeded the UCSF criteria. CONCLUSIONS Fluorodeoxyglucose-positron emission tomography/computed tomography has a low degree of use in patients with hepatocellular carcinoma that falls within the Milan criteria and should not be routinely used as part of the liver transplant work-up.
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Affiliation(s)
- Faisal Alotaibi
- Department of Liver & Small Bowel Transplantation & Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Castilla-Lièvre MA, Franco D, Gervais P, Kuhnast B, Agostini H, Marthey L, Désarnaud S, Helal BO. Diagnostic value of combining 11C-choline and 18F-FDG PET/CT in hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2015; 43:852-859. [DOI: 10.1007/s00259-015-3241-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/27/2015] [Indexed: 12/13/2022]
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Diagnostic accuracy of 11C-choline PET/CT in comparison with CT and/or MRI in patients with hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2015; 42:1399-407. [DOI: 10.1007/s00259-015-3079-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/28/2015] [Indexed: 12/11/2022]
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D'souza MM, Sharma R, Jaimini A, Saw SK, Singh D, Mondal A. Combined (18)F-FDG and (11)C-Methionine PET/CT scans in a case of metastatic hepatocellular carcinoma. Indian J Nucl Med 2014; 29:171-4. [PMID: 25210286 PMCID: PMC4157194 DOI: 10.4103/0972-3919.136579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A 37-year-old male who underwent a central hepatectomy of the liver for hepatocellular carcinoma (HCC) was referred for an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) study to rule out tumor recurrence or metastases. The scan showed a recurrent hepatic mass at the operative site, along with low-grade uptake in bilateral pulmonary metastases, mediastinal and hilar lymph nodes, and few skeletal sites. A non-FDG avid intracranial extradural mass was visualized in the right frontal lobe. The 11C-methionine PET/CT scan performed subsequently revealed a larger area of involvement at the primary site, along with widespread metastases to the lungs, mediastinal, hilar, and abdominal lymph nodes, and multiple skeletal sites. Further, dural metastasis with high tracer uptake was noted in the frontal region. To the best of our knowledge, this is the first case documented in the literature, wherein 11C-methionine PET/CT played a significant role in delineating the widespread dissemination, including the extremely rare dural involvement in a case of HCC. This report highlights the potential value of 11C-methionine PET/CT in assessing the hepatic and extrahepatic tumor burden in cases of HCC, especially in clinically unexpected locations.
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Affiliation(s)
- Maria M D'souza
- Department of Positron Emission Tomography Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Rajnish Sharma
- Department of Positron Emission Tomography Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Abhinav Jaimini
- Department of Positron Emission Tomography Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Sanjiv Kumar Saw
- Department of Positron Emission Tomography Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Dinesh Singh
- Department of Positron Emission Tomography Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Anupam Mondal
- Department of Positron Emission Tomography Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
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Bieze M, Klümpen HJ, Verheij J, Beuers U, Phoa SSKS, van Gulik TM, Bennink RJ. Diagnostic accuracy of (18) F-methylcholine positron emission tomography/computed tomography for intra- and extrahepatic hepatocellular carcinoma. Hepatology 2014; 59:996-1006. [PMID: 24123111 DOI: 10.1002/hep.26781] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/16/2013] [Accepted: 10/01/2013] [Indexed: 12/26/2022]
Abstract
UNLABELLED Diagnosis of hepatocellular carcinoma (HCC) primarily involves imaging. The aim of this study was to assess the accuracy of (18) F-fluorocholine ((18) F-FCH) positron emission tomography (PET) for detection of HCC and evaluation of extent of disease. Patients with HCC >1 cm were included between 2009 and July 2011, and follow-up closed in February 2013. Diagnosis was based on American Association for the Study of Liver Diseases criteria, and all patients underwent (18) F-FCH PET/computed tomography (CT) at baseline before treatment, 6 underwent a second PET/CT posttreatment, and 1 a third during follow-up. Whole-body PET and low-dose CT imaging were performed 15 minutes after (18) F-FCH injection. Evaluation of imaging was done with standardized uptake value (SUV) ratios: SUV maximum of the lesion divided by the SUV mean of surrounding tissue. Statistical analyses included descriptive analyses, receiver operating characteristic curve, McNemar's test, and Kaplan-Meier's test at 5% level of significance. Twenty-nine patients revealed 53 intrahepatic lesions. In 48 of 53 lesions, (18) F-FCH PET was positive (SUVratio , 1.95 ± 0.66; sensitivity, 88%; specificity, 100%). PET/CT showed uptake in 18 extrahepatic lesions and no uptake in 3 lesions affirmed non-HCC lesions; all lesions were confirmed with additional investigation (accuracy, 100%). In 17 of 29 patients, additional lesions were found on PET/CT imaging, with implications for treatment in 15 patients. Posttreatment PET/CT showed identical results, compared with standard treatment evaluation. CONCLUSION This study shows additional value of (18) F-FCH PET/CT for patients with HCC. (18) F-FCH PET/CT has implications for staging, management, and treatment evaluation because of accurate assessment of extrahepatic disease.
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Affiliation(s)
- Matthanja Bieze
- Departments of Surgery, Academic Medical Center, the Netherlands
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Nabavi SF, Daglia M, Moghaddam AH, Habtemariam S, Nabavi SM. Curcumin and Liver Disease: from Chemistry to Medicine. Compr Rev Food Sci Food Saf 2013; 13:62-77. [DOI: 10.1111/1541-4337.12047] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/23/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Seyed Fazel Nabavi
- Applied Biotechnology Research Center; Baqiyatallah Univ. of Medical Sciences; Tehran Iran
| | - Maria Daglia
- Dept. of Drug Sciences; Univ. of Pavia, Medicinal Chemistry and Pharmaceutical Technology Section; via Taramelli 12 27100 Pavia Italy
| | - Akbar Hajizadeh Moghaddam
- Amol Univ. of Special Modern Technologies; Amol Iran
- Dept. of Biology; Faculty of basic science; Univ. of Mazandaran; Babolsar Iran
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories; Medway School of Science, Univ. of Greenwich; Central Ave. Chatham-Maritime Kent ME4 4TB U.K
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research Center; Baqiyatallah Univ. of Medical Sciences; Tehran Iran
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Talbot JN, Fartoux L, Balogova S, Nataf V, Kerrou K, Gutman F, Huchet V, Ancel D, Grange JD, Rosmorduc O. Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med 2010; 51:1699-706. [PMID: 20956466 DOI: 10.2967/jnumed.110.075507] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED This prospective study aimed to compare the diagnostic performance of (18)F-fluorocholine and (18)F-FDG for detecting and staging hepatocellular carcinoma (HCC) in patients with chronic liver disease and suspected liver nodules. METHODS Whole-body PET/CT was performed in a random order at 10 min after injection of 4 MBq of (18)F-fluorocholine per kilogram and at 1 h after injection of 5 MBq of (18)F-FDG per kilogram. PET/CT results were read in a masked manner by 2 specialists, and diagnostic performance was assessed from the results of consensus masked reading. Those focal lesions appearing with increased or decreased activity, compared with background, on (18)F-fluorocholine PET/CT were considered positive for malignancy. The standard of truth was determined on a per-site basis using data from a histologic examination and a follow-up period of more than 6 mo; on a per-patient basis, the Barcelona criteria were also accepted as a proof of HCC in 5 patients. RESULTS Eighty-one patients were recruited; standard of truth was determined in 59 cases. HCC was diagnosed in 34 patients. Therefore, sensitivity was 88% for (18)F-fluorocholine and 68% for (18)F-FDG (P = 0.07), and in 70 sites, sensitivity was 84% for (18)F-fluorocholine, significantly better than the 67% for (18)F-FDG (P = 0.01). Of the 11 patients with well-differentiated HCC, 6 had a positive result with (18)F-fluorocholine alone, whereas (18)F-FDG was never positive alone; corresponding site-based sensitivity was 94% for (18)F-fluorocholine and 59% for (18)F-FDG (P = 0.001). The detection rate of 18 sites corresponding to other malignancies was 78% for (18)F-fluorocholine and 89% for (18)F-FDG. In nonmalignant sites, (18)F-fluorocholine appeared less specific than (18)F-FDG (62% vs. 91% P < 0.01) because of uptake by focal nodular hyperplasia. CONCLUSION (18)F-fluorocholine was significantly more sensitive than (18)F-FDG at detecting HCC, in particular in well-differentiated forms. In contrast, (18)F-FDG appeared somewhat more sensitive at detecting other malignancies and was negative in focal nodular hyperplasia. Thus (18)F-fluorocholine appears to be a useful PET/CT tracer for the detection and surveillance of HCC; however, performing PET/CT with both radiopharmaceuticals seems to be the best option.
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Affiliation(s)
- Jean-Noël Talbot
- Department of Nuclear Medicine, Hôpital Tenon, AP-HP and Université Pierre et Maris Curie, Paris, France.
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Dual time point C-11 acetate PET imaging can potentially distinguish focal nodular hyperplasia from primary hepatocellular carcinoma. Clin Nucl Med 2010; 34:874-7. [PMID: 20139820 DOI: 10.1097/rlu.0b013e3181bed06e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
C-11 acetate positron emission tomography (PET) is known to have high sensitivity in detecting hepatocellular carcinoma. However, one of the shortcomings of C-11 acetate PET in the diagnosis of hepatocellular carcinoma is that C-11 acetate also accumulates in focal nodular hyperplasia, which makes it challenging to distinguish hepatocellular carcinoma form focal nodular hyperplasia when a conventional single time point PET imaging method is used. Two patients with suspected hepatocellular carcinoma and negative fluoro-deoxy-glucose PET scans underwent C-11 acetate PET dual time imaging in which both early and delayed images were acquired. One patient was subsequently confirmed having hepatocellular carcinoma while the other had focal nodular hyperplasia. C-11 acetate imaging was positive in both patients. Interestingly, in hepatocellular carcinoma the C-11 acetate activity in the delayed images is higher than in the early images while in focal nodular hyperplasia, the C-11 acetate activity decreased in the delayed image when compared with early images. Our findings suggest that dual time point imaging has potential to improve the diagnostic accuracy of C-11 acetate PET in the diagnosis of hepatocellular carcinoma.
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Risse JH, Pauleit D, Bender H, Rabe C, Fischer HP, Biersack HJ, Bucerius J. 18F-FDG-PET and Histopathology in 131I-Lipiodol Treatment for Primary Liver Cancer. Cancer Biother Radiopharm 2009; 24:445-52. [DOI: 10.1089/cbr.2008.0560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Jörn H. Risse
- Radiology and Nuclear Medicine Institute, Bad Honnef, Germany
- Department of Nuclear Medicine, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Dirk Pauleit
- Radiology and Nuclear Medicine Institute, Bad Honnef, Germany
- Institute of Medicine, Research Center Jülich, Jülich, Germany
| | - Hans Bender
- Department of Nuclear Medicine, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
- Department of Nuclear Medicine, Roentgeninstitut Düsseldorf, Düsseldorf, Germany
| | - Christian Rabe
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Hans-Peter Fischer
- Institute of Pathology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Hans-Jürgen Biersack
- Department of Nuclear Medicine, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Jan Bucerius
- Department of Nuclear Medicine, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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Park JW, Kim JH, Kim SK, Kang KW, Park KW, Choi JI, Lee WJ, Kim CM, Nam BH. A prospective evaluation of 18F-FDG and 11C-acetate PET/CT for detection of primary and metastatic hepatocellular carcinoma. J Nucl Med 2008; 49:1912-21. [PMID: 18997056 DOI: 10.2967/jnumed.108.055087] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED Because (18)F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), (11)C-acetate PET has been proposed as another technique for this use. We prospectively evaluated the value of PET/CT using these 2 tracers for the detection of primary and metastatic HCC. METHODS One hundred twelve patients (99 with HCC, 13 with cholangiocellular carcinoma) underwent biopsy and (18)F-FDG and (11)C-acetate PET/CT. RESULTS The overall sensitivities of (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT in the detection of 110 lesions in 90 patients with primary HCC were 60.9%, 75.4%, and 82.7%, respectively. Elevated serum alpha-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive (18)F-FDG PET/CT results. Uptake of (11)C-acetate was associated with large and multiple tumors. For (18)F-FDG, the sensitivities according to tumor size (1-2, 2-5, and >/=5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for (11)C-acetate, these respective values were 31.8%, 78.2%, and 95.2%. (18)F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with (18)F-FDG PET/CT positive for all indexed lesions than in those with FDG negative or partially positive through the entire follow-up period. In analysis based on biopsied lesions, the sensitivity of (18)F-FDG PET/CT was 64.4% for primary HCC and 84.4% for (11)C-acetate PET/CT. The overall sensitivities of (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT for 35 metastatic HCCs were 85.7%, 77.0%, and 85.7%, respectively. There was no significant difference in the sensitivity of tracers according to metastatic tumor size, location, or differentiation. CONCLUSION The addition of (11)C-acetate to (18)F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but (18)F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.
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Affiliation(s)
- Joong-Won Park
- Center for Liver Cancer, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
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Impact of whole-body imaging on treatment decision to radio-frequency ablation in patients with malignant liver tumors: comparison of [18F]fluorodeoxyglucose-PET/computed tomography, PET and computed tomography. Nucl Med Commun 2008; 29:599-606. [PMID: 18528181 DOI: 10.1097/mnm.0b013e3282f8144d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The correct staging of patients with malignant liver tumors before radio-frequency ablation (RFA) is mandatory for successful treatment. Our study aimed to compare the influence on decision to perform RFA of whole-body fluorodeoxyglucose (FDG)-PET/computed tomography (CT) with whole-body contrast-enhanced CT (CE-CT) and PET alone. METHODS Fifty-eight patients with known hepatic malignancies (23, liver metastases 35) received FDG-PET/CT before RFA planned with curative intention. CT and PET data were each read separately, PET/CT fusion data were read in consensus afterward by a third reader group. The diagnostic accuracy of CE-CT, PET alone, and PET/CT to identify patients eligible for RFA was compared and the impact on decision was analyzed. The McNemar test with Bonferroni correction was used to test for significant differences. RESULTS The accuracy and sensitivity to detect correctly intrahepatic and extrahepatic tumor were 94 and 97% for CT, 75 and 54% for PET, and 97 and 95% for PET/CT. The differences between CT and PET, as well as between PET/CT and PET, were statistically significant, but there was no significant difference between PET/CT and CT alone (P>0.65). PET alone, CE-CT, and PET/CT correctly identified 32, 55, and 57 patients, respectively. Again, PET/CT showed no significant advantage over CE-CT. Both imaging methods performed significantly better than PET alone (P<0.0001). Forty-three (74%) of 58 patients underwent RFA with curative intention. CONCLUSION Whole-body imaging changed patient management in 26% of the patients planned for curative intended RFA, yet there was no significant difference between CE-CT and PET/CT.
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Abstract
The clinical usefulness of FDG-PET imaging is now firmly established in various situations, such as the preoperative staging of esophageal cancer and recurrent colorectal carcinoma and the detection and staging of recurrent colorectal cancer when there is a clinical or biologic suspicion with inconclusive conventional findings. Encouraging results were obtained in the evaluation of the therapeutic response of various gastrointestinal malignancies, either during the treatment or after its completion. There is no firm consensus regarding its role in pancreatic cancer, either proved or suspected, but it may be valuable in selected clinical situations. Its role seems fairly limited in patients with hepatocellular carcinoma, although PET findings may have prognostic implications. Evaluation of cholangiocarcinoma is an emerging indication, albeit with limited data to date. Finally, PET/CT is very likely to enhance the role of FDG imaging further in the work-up of patients with gastrointestinal tumors.
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Affiliation(s)
- Roland Hustinx
- Division of Nuclear Medicine, University Hospital of Liège, Campus Universitaire du Sart Tilman B35, 4000 Liège, Belgium.
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Abstract
Molecular imaging may be defined as spatially localized and/or temporally resolved sensing of molecular and cellular processes in vivo. An imageable molecular event may be the result of the overexpression of a gene that produces a specific messenger RNA. The overexpressed protein could be an enzyme or could be incorporated into cell-surface transporters or receptors. Any step of this process is a potential target for molecular imaging. Current molecular imaging modalities include magnetic resonance imaging, nuclear imaging, ultrasound, and optical imaging. Nuclear medicine has been at the forefront of molecular imaging because of the relatively high sensitivity to detect nanomolar or picomolar quantities of the radiolabeled imaging probe. Imaging has had a central role in the diagnosis of hepatocellular carcinoma (HCC), which is considered the fifth most frequent malignancy worldwide. Nuclear imaging was one of the earlier modalities used for liver imaging. Traditional tracers included technetium 99m ( 99m Tc) sulfur colloid, gallium 67, and 99m Tc iminodiacetate acid analogues. Other less traditional probes include 99m Tc diethylenetriamine pentaacetic acid-galactosyl-human serum albumin for evaluation of functional liver volume and 99m Tc-labeled tetrofosmin and methoxisobutylisonitrile for detecting drug resistance. Fluorodeoxyglucose is the most widely used probe for positron emission tomography (PET) tumor imaging; however, carbon 11-labeled acetate appears to show improved sensitivity and specificity for HCC. Oxygen 15 PET imaging allows for the measurement of hepatic and tumor blood flow. Difficulties developing specific imaging methods for HCC are caused by the lack of obvious specific molecular targets, problems with drug delivery, and poor contrast-to-noise. No magic molecular imaging method exists today to accurately detect, characterize, and monitor HCC in vivo.
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Affiliation(s)
- Ahmed M Gharib
- Department of Radiology, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
This article provides a brief overview of the current status of commonly employed diagnostic techniques--US, CT, MR, and PET--for the evaluation of liver metastases and HCC as well as a description of imaging in RF ablation and liver transplantation. The various advantages and limitations of the techniques have been outlined. At the present time, at our center, MRI is used most often to evaluate these liver pathologies, due to its high accuracy for lesion detection and characterization.
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Affiliation(s)
- Larissa Braga
- Department of Radiology, University of North Carolina at Chapel Hill, 10 Manning Drive, CB# 7510, Chapel Hill, NC 27599-7510, USA
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Annovazzi A, Peeters M, Maenhout A, Signore A, Dierckx R, Van De Wiele C. 18-fluorodeoxyglucose positron emission tomography in nonendocrine neoplastic disorders of the gastrointestinal tract. Gastroenterology 2003; 125:1235-45. [PMID: 14517805 DOI: 10.1016/s0016-5085(03)01208-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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KRUG BRUNO, MARTINET JEANPAUL, LACROSSE MARC, DELOS MONIQUE, BORGHT THIERRYVANDER. A Well-Differentiated Hepatocellular Carcinoma Detected Only by F-18 FDG Positron Emissio Tomography. Clin Nucl Med 2003. [DOI: 10.1097/00003072-200307000-00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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