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Mititelu R, Mitoi A, Mazilu C, Jinga M, Radu FI, Bucurica A, Mititelu T, Bucurica S. Advancements in hepatocellular carcinoma management: the role of 18F-FDG PET-CT in diagnosing portal vein tumor thrombosis. Nucl Med Commun 2024:00006231-990000000-00302. [PMID: 38757155 DOI: 10.1097/mnm.0000000000001863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Portal vein thrombosis, a relatively frequent complication associated with hepatocellular carcinoma (HCC) and liver cirrhosis, is recognized as a significant global health concern. This is mainly due to these conditions' high prevalence and potentially severe outcomes. The aim of our study was to conduct a comprehensive literature review to evaluate the efficacy, accuracy, and clinical implications of 18F-FDG PET-CT in diagnosing and managing portal vein tumor thrombosis (PVTT) in patients with HCC. HCC, which accounts for 80% of liver malignancies, ranks as the fourth most prevalent cancer globally and is a significant contributor to cancer-related mortality. The majority of HCC patients are diagnosed at an advanced stage, leading to a deterioration in patient outcomes. Involvement of the portal vein is also a significant negative factor. This review analyzes the application of 18F-FDG PET-CT in the detection and management of PVTT in patients with HCC, with an emphasis on the importance of the maximum standardized uptake value as an essential diagnostic and prognostic marker. 18F-FDG PET-CT is invaluable for detecting recurrence and guiding management strategies, particularly in patients with high-grade HCC, and plays a pivotal role in differentiating malignant portal vein thrombi from their benign counterparts.
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Affiliation(s)
- Raluca Mititelu
- Department of Nuclear Medicine, University of Medicine and Pharmacy Carol Davila
- Department of Nuclear Medicine, University Emergency Central Military Hospital
| | - Alexandru Mitoi
- Department of Nuclear Medicine, University Emergency Central Military Hospital
| | - Catalin Mazilu
- Department of Nuclear Medicine, University Emergency Central Military Hospital
| | - Mariana Jinga
- Department of Internal Medicine and Gastroenterology, University of Medicine and Pharmacy Carol Davila
- Department of Gastroenterology, University Emergency Central Military Hospital
| | - Florentina Ionita Radu
- Department of Internal Medicine and Gastroenterology, University of Medicine and Pharmacy Carol Davila
- Department of Gastroenterology, University Emergency Central Military Hospital
| | - Ana Bucurica
- Faculty of General Medicine, University of Medicine and Pharmacy Carol Davila
| | - Teodora Mititelu
- Faculty of General Medicine, University of Medicine and Pharmacy Carol Davila
- Institute of Military Medicine, Bucharest, Romania
| | - Sandica Bucurica
- Department of Internal Medicine and Gastroenterology, University of Medicine and Pharmacy Carol Davila
- Department of Gastroenterology, University Emergency Central Military Hospital
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Anılır E, Oral A, Turker F, Şahin T, Topçu FS, Yuzer Y, Tokat Y. Predictive Value of Preoperative 18 Fludeoxyglucose Positron Emission Tomography-Computed Tomography for Survival in Liver Transplantation Due to Hepatocellular Cancer. Transplant Proc 2024; 56:111-115. [PMID: 38212168 DOI: 10.1016/j.transproceed.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/21/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND We aimed to study the predictive value of preoperative perform [18F] Fludeoxyglucose positron emission tomography-computed tomography ([18] FDG PET-CT) for survival in liver transplantation due to hepatocellular cancer. METHODS Ninety-six patients who underwent liver transplantation for hepatocellular cancer (HCC) after preoperative PET-CT evaluation were examined for the study. All patients' ages, genders, body mass index, blood groups, Child-Pugh and Model for End-Stage Liver Disease scores, etiologies, median Alpha Fetoprotein values, Milan Criteria and T stages, grades, macrovascular and microvascular invasions, multicentricities, maximum and total tumor sizes, tumor number findings in explant specimens, and recurrence rates were analyzed statistically. RESULTS Statistically, microvascular (P = .002) and macrovascular invasions (P = .034) were observed more frequently in patients who are PET-CT (+) compared with patients who are PET-CT (-). PET-CT positivity was associated with shortened disease-free survival (DFS) statistically (P = .004). CONCLUSION Positron emission tomography-CT positivity may be important for predicting prognostic markers such as DFS and vascular invasion in the preoperative evaluation. Before transplantation, PET-CT should be applied to all patients with HCC.
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Affiliation(s)
- Ender Anılır
- İstanbul Aydın University, VMV Medikalpark Florya Hospital Transplantation Center.
| | | | - Fatih Turker
- Haseki Education and Research Hospital İnternal Medicine Clinic
| | - Tolga Şahin
- Demiroğlu Bilim University Group Florence Nightingale Hospitals Liver Transplantation Center and Hepatology Department
| | - Feyza Sönmez Topçu
- İstanbul Aydın University Medikalpark Florya Hospital, Radiology Department
| | - Yıldıray Yuzer
- Demiroğlu Bilim University Group Florence Nightingale Hospitals Liver Transplantation Center
| | - Yaman Tokat
- Acıbadem Fulya Hospital, Hepatobiliary and Liver Transplantation Department
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Belfiore MP, De Chiara M, Reginelli A, Clemente A, Urraro F, Grassi R, Belfiore G, Cappabianca S. An overview of the irreversible electroporation for the treatment of liver metastases: When to use it. Front Oncol 2022; 12:943176. [PMID: 36119531 PMCID: PMC9477084 DOI: 10.3389/fonc.2022.943176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Tumour ablation is an established therapy for local treatment of liver metastases and hepatocellular carcinoma. Most commonly two different kind of thermic ablation, radiofrequency ablation and microwave ablation, are used in clinical practice. The aim of both is to induce thermic damage to the malignant cells in order to obtain coagulative necrosis of the neoplastic lesions. Our main concerns about these procedures are the collateral thermic damage to adjacent structures and heat-sink effect. Irreversible electroporation (IRE) is a recently developed, non-thermal ablation procedure which works applying short pulses of direct current that generate an electric field in the lesion area. The electric field increase the transmembrane potential, changing its permeability to ions.Irreversible electroporation does not generate heat, giving the chance to avoid the heat-sink effect and opening the path to a better treatment of all the lesions located in close proximity to big vessels and bile ducts. Electric fields produced by the IRE may affect endothelial cells and cholangiocytes but they spare the collagen matrix, preserving re-epithelization process as well as the function of the damaged structures. Purpose of the authors is to identify the different scenarios where CT-guided percutaneous IRE of the liver should be preferred to other ablative techniques and why.
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Affiliation(s)
- Maria Paola Belfiore
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
- *Correspondence: Maria Paola Belfiore,
| | - Marco De Chiara
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Alfonso Reginelli
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Alfredo Clemente
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Fabrizio Urraro
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Roberto Grassi
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Giuseppe Belfiore
- Department of Diagnostic Imaging, Nursing home L.Cobellis, Vallo della Lucania Salerno, Italy
| | - Salvatore Cappabianca
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
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COŞKUN N, YÜKSEL AÖ, CANYİĞİT M, ÖZDEMİR E. Radiomics analysis of pre-treatment F-18 FDG PET/CT for predicting response to transarterial radioembolization in liver tumors. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1118649] [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] Open
Abstract
Aim: To investigate the relationship between the textural features extracted from pre-treatment fluorine-18 fluorodeoxyglucose positron emission with computed tomography (F-18 FDG PET/CT) and the response to treatment in patients undergoing transarterial radioembolization (TARE) due to primary or metastatic liver tumors.
Material and Method: A total of 25 liver lesions from the pre-treatment F-18 PET/CT images of 14 patients were segmented manually. Standard uptake value (SUV) metrics and radiomics features were extracted for each lesion. Metabolic treatment response was determined according to PERCIST criteria in 18F-FDG PET/CT imaging performed 2 months after the treatment. Feature selection was done with recursive feature elimination (RFE). The association between selected features and treatment response was evaluated with logistic regression analysis.
Results: Eventually, 13 lesions responded to TARE, while 12 lesions remain stable or progressed. All standard uptake values and 27 out of 30 textural heterogeneity indicators were significantly higher in lesions that responded to treatment. SUVmax, kurtosis and dissimilarity features were selected by the RFE algorithm for the prediction of response to TARE. Logistic regression analysis revealed that all three parameters were significantly associated with treatment outcome.
Conclusion: Textural features extracted from pre-treatment F-18 FDG PET/CT in patients undergoing TARE due to liver tumors are promising biomarkers that can be potentially used to predict metabolic treatment response.
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Affiliation(s)
- Nazım COŞKUN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
| | - Alptuğ Özer YÜKSEL
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, NÜKLEER TIP ANABİLİM DALI
| | - Murat CANYİĞİT
- YILDIRIM BEYAZIT ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, RADYOLOJİ ANABİLİM DALI
| | - Elif ÖZDEMİR
- YILDIRIM BEYAZIT ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, NÜKLEER TIP ANABİLİM DALI
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Lee H, Choi JY, Joung JG, Joh JW, Kim JM, Hyun SH. Metabolism-Associated Gene Signatures for FDG Avidity on PET/CT and Prognostic Validation in Hepatocellular Carcinoma. Front Oncol 2022; 12:845900. [PMID: 35174098 PMCID: PMC8841806 DOI: 10.3389/fonc.2022.845900] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe prognostic value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in hepatocellular carcinoma (HCC) was established in previous reports. However, there is no evidence suggesting the prognostic value of transcriptomes associated with tumor FDG uptake in HCC. It was aimed to elucidate metabolic genes and functions associated with FDG uptake, followed by assessment of those prognostic value.MethodsSixty HCC patients with Edmondson–Steiner grade II were included. FDG PET/CT scans were performed before any treatment. RNA sequencing data were obtained from tumor and normal liver tissue. Associations between each metabolism-associated gene and tumor FDG uptake were investigated by Pearson correlation analyses. A novel score between glucose and lipid metabolism-associated gene expression was calculated. In The Cancer Genome Atlas Liver Hepatocellular Carcinoma dataset, the prognostic power of selected metabolism-associated genes and a novel score was evaluated for external validation.ResultsNine genes related to glycolysis and the HIF-1 signaling pathway showed positive correlations with tumor FDG uptake; 21 genes related to fatty acid metabolism and the PPAR signaling pathway demonstrated negative correlations. Seven potential biomarker genes, PFKFB4, ALDOA, EGLN3, EHHADH, GAPDH, HMGCS2, and ENO2 were identified. A metabolic gene expression balance score according to the dominance between glucose and lipid metabolism demonstrated good prognostic value in HCC.ConclusionsThe transcriptomic evidence of this study strongly supports the prognostic power of FDG PET/CT and indicates the potential usefulness of FDG PET/CT imaging biomarkers to select appropriate patients for metabolism-targeted therapy in HCC.
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Affiliation(s)
- Hyunjong Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Je-Gun Joung
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam, South Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Seung Hyup Hyun,
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Winkens T, Rudakoff W, Rauchfuss F, Malessa C, Settmacher U, Freesmeyer M. FDG PET/CT to Detect Incidental Findings in Patients With Hepatocellular Carcinoma-Additional Benefit for Patients Considered for Liver Transplantation? Clin Nucl Med 2021; 46:532-539. [PMID: 33661197 DOI: 10.1097/rlu.0000000000003576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE FDG PET/CT has been described for noninvasive grading, detection of extrahepatic spread, and recurrence in hepatocellular carcinoma (HCC). As compared with localized imaging approaches (MRI, ultrasonography), FDG PET/CT not only focuses on the liver, but covers a long field of view from the base of the skull to the thighs, visualizing pathologic findings not related to HCC. The aims of this retrospective study were to (1) describe the frequency of relevant incidental findings on FDG PET/CT in HCC patients, (2) evaluate the impact on treatment strategy in HCC patients considered for liver transplantation, and (3) to discuss the role of FDG PET/CT in patients considered for transplantation in general. METHODS Four hundred thirty-nine FDG PET/CT examinations of 345 HCC patients were screened for incidental findings. The clinical information system was searched for examinations performed after FDG PET/CT and aimed at verification of incidental findings. Of 345 HCC patients, 81 patients were considered for liver transplantation. The impact of incidental findings was recorded separately for this subgroup. RESULTS One hundred one patients with incidental findings in 439 FDG PET/CT examinations were identified. The incidental findings comprised 22 neoplasms (9 malignant) and 52 inflammations. Liver transplantation was not performed because of an incidental finding on FDG PET/CT in 9 (11.1%) of 81 patients. CONCLUSIONS FDG PET/CT is capable of identifying relevant incidental findings (ie, secondary malignancy, benign tumors, and inflammation) in HCC patients and HCC patients considered for liver transplantation and thus influencing HCC patient management. FDG PET/CT might also be beneficial in patients considered for transplantation of different organs.
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Affiliation(s)
| | | | - Falk Rauchfuss
- Clinic of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Christina Malessa
- Clinic of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Utz Settmacher
- Clinic of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
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Abouzied MM, Alhinti N, AlMuhaideb A, Al Sugair AS, Al Qahtani M. Extrahepatic metastases from hepatocellular carcinoma: multimodality image evaluation. Nucl Med Commun 2021; 42:583-591. [PMID: 33625188 DOI: 10.1097/mnm.0000000000001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most prevalent primary malignancy of the liver is hepatocellular carcinoma (HCC); its poor prognosis is mainly related to intrahepatic recurrence and extrahepatic metastases. However, survival from HCC has improved due to better control of the primary tumor, the development of newer treatment modalities, including liver transplant, together with advances in imaging techniques. Therefore, the significance of patient management as corresponds with distant metastases has increased; since the proper evaluation and detection of extrahepatic metastases is crucial to optimize potential therapy for patients. Conventional imaging like CT, MRI play crucial rule in patient's diagnosis and qualifying for a certain type of therapy. More recently, a molecular imaging tool with radiolabeled deoxyglucose and fluorocholine has proved its promising value as a complementary tool to conventional studies. In this review, the frequent sites of metastases and HCC spread are discussed as well as the imaging findings as seen by both conventional imaging techniques and by molecular imaging tools, namely 18F-Choline PET/CT, and FDG PET. The implications of guiding treatment planning have also been discussed.
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Affiliation(s)
| | - Nayef Alhinti
- Department of Radiology, King Faisal Specialist Hospital & Research Centre
| | - Ahmad AlMuhaideb
- Department of Radiology, King Faisal Specialist Hospital & Research Centre
| | | | - Mohammed Al Qahtani
- Cyclotron and Radiopharmaceuticals Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Bhangui P, Saigal S, Gautam D, Piplani T, Choudhary N, Chaudhary R, Yadav S, Thiagarajan S, Rastogi A, Saraf N, Nundy S, Soin AS. Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria. Liver Transpl 2021; 27:209-221. [PMID: 37160010 DOI: 10.1002/lt.25956] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/09/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
Conventional selection criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) are based on tumour size/number only, and do not consider vital surrogates of tumor biology such as alpha-fetoprotein (AFP) and tumor [18 F]fluorodeoxyglucose positron emission tomography ([18 F]FDG PET) avidity. We analyzed survival outcomes, and predictors of HCC recurrence in 405 patients with cirrhosis and HCC (HCC-cirr) who underwent living donor LT (LDLT) using our expanded selection criteria: no extrahepatic disease or major vascular invasion, irrespective of tumor size/number. Fifty-one percent patients had tumours beyond Milan, and 43% beyond the University of California San Francisco [UCSF] criteria. The 5-year overall survival (OS) and recurrence-free survival (RFS) were 64% and 70%, respectively. Three preoperatively available factors predicted recurrence: pre-LT AFP ≥100 ng/mL (P = 0.005; hazard ratio [HR], 2.190), tumor burden beyond the UCSF criteria (P = 0.001; HR, 2.640), and [18 F]FDG PET avidity (P = 0.004; HR, 2.442). A prognostic model based on the number and combination of the aforementioned preoperative risk factors was developed using a competing-risk RFS model. Three risk groups were identified: low (none or a single risk factor present, 9.3% recurrence), moderate (AFP ≥100 ng/mL and [18 F]FDG PET avidity, or beyond UCSF tumor and [18 F]FDG PET avidity, 25% recurrence), and high (AFP ≥100 ng/mL and beyond UCSF, or presence of all 3 risk factors, 46% recurrence). Acceptable long-term outcomes were achieved using our expanded selection criteria. Our prognostic model to predict recurrence based on preoperative biological and morphological factors could guide pretransplant management (downstaging versus upfront LDLT) with the aim of reducing post-LDLT recurrence.
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Affiliation(s)
- Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Sanjiv Saigal
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Dheeraj Gautam
- Department of Pathology, Medanta-The Medicity, Delhi NCR, India
| | - Tarun Piplani
- Department of Radiodiagnosis and Interventional Radiology, Medanta-The Medicity, Delhi NCR, India
| | - Narendra Choudhary
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Rohan Chaudhary
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Sanjay Yadav
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - S Thiagarajan
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Amit Rastogi
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Neeraj Saraf
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Gangaram Hospital, New Delhi, India
| | - A S Soin
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
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Radiolabelled PSMA PET/CT or PET/MRI in hepatocellular carcinoma (HCC): a systematic review. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Introduction
Radiolabelled prostate-specific membrane antigen PSMA-based PET/CT or PET/MRI is a whole-body imaging technique usually performed for the detection of prostate cancer lesions. PSMA has been also demonstrated to be expressed by the neovasculature of many other solid tumors. The aim of this review is to evaluate the possible diagnostic role of radiolabelled PSMA PET/CT or PET/MRI in patients with hepatocellular carcinoma, by summarizing the available literature data.
Methods
A wide literature search of the PubMed/MEDLINE, Scopus, Embase and Cochrane library databases was made to find relevant published articles about the diagnostic performance of radiolabelled PSMA binding agents in PET/CT or PET/MRI imaging of patients with hepatocellular carcinoma.
Results
Ten case reports and three studies showed that hepatocellular carcinoma is PSMA-avid.
Conclusion
Radiolabelled PSMA imaging seems to be useful in analyzing hepatocellular carcinoma. Further studies enrolling a wider population are needed to clarify the real clinical and diagnostic role of radiolabelled PSMA in this setting.
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Ding E, Lu D, Wei L, Feng X, Shen J, Xu W. Predicting tumor recurrence using metabolic indices of 18F-FDG PET/CT prior to orthotopic liver transplantationfor hepatocellular carcinoma. Oncol Lett 2020; 20:1245-1255. [PMID: 32724365 PMCID: PMC7377045 DOI: 10.3892/ol.2020.11681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/06/2019] [Indexed: 12/13/2022] Open
Abstract
The present study analyzed the ability of metabolic burden indices from 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to predict tumor recurrence following orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC). Seven major metabolic indices were measured by 18F-FDG PET/CT in 93 patients with HCC, prior to OLT. The Mann-Whitney U test was then used to predict the association of metabolic indices, including the maximum standardized uptake value (SUVmax), tumor-to-mediastinum SUV ratio, tumor-to-normal-liver SUV ratio, SUV normalized to lean body mass metabolic tumor volume (MTV), total lesion glycolysis (TLG) and uptake-volume product (UVP), with the recurrence risk. The Deauville-like scoring system was used to quantify the recurrence risk. Univariate and multivariable Cox regression models were performed to determine survival rate. The results showed that Deauville-like score (PET-negative vs. -positive), MTV (cutoff value, 13.36), TLG (cutoff value, 62.21) and UVP (cutoff value, 66.60) had high prediction performance for tumor recurrence (P<0.05). TLG had the highest receiver operating characteristics area under the curve of 0.725. Among the clinical factors, high level of α-fetoprotein (AFP, ≥144 ng/ml), Milan criteria, tumor number (>3), involvement of both right and left lobes, and tumor size (>5 cm) were found to be significant predictors of tumor recurrence. Patients in the low metabolic group had longer recurrence-free survival (RFS) times compared with those in the high metabolic group, regardless of whether they met the Milan criteria or not. AFP, uptake-volume product according the SUV mean of mediastinum (UVP-M), Milan criteria, lymph node metastasis, and the number of tumors were significant prognostic factors for RFS (P<0.05) in both univariate and multivariate survival analyses. Additionally, the MVI was a significant prognostic factor based on univariate survival analyses. Overall, the present study demonstrated the metabolic burden indices measured by PET/CT, Deauville-like score, MTV, TLG and UVP as significant prognostic factors in patients with HCC following OLT. The combination of metabolic indices measured by PET/CT and the existing criteria, such as the Milan criteria, may play an important role in evaluating the suitability of OLT in specific patients.
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Affiliation(s)
- Enci Ding
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China.,Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Dongyan Lu
- Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Lijuan Wei
- Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Xuemin Feng
- Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Jie Shen
- Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
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11
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PET in Gastrointestinal, Pancreatic, and Liver Cancers. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Zeng YR, Yang QH, Liu QY, Min J, Li HG, Liu ZF, Li JX. Dual energy computed tomography for detection of metastatic lymph nodes in patients with hepatocellular carcinoma. World J Gastroenterol 2019; 25:1986-1996. [PMID: 31086466 PMCID: PMC6487382 DOI: 10.3748/wjg.v25.i16.1986] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Regional lymph node metastasis in patients with hepatocellular carcinoma (HCC) is not uncommon, and is often under- or misdiagnosed. Regional lymph node metastasis is associated with a negative prognosis in patients with HCC, and surgical resection of lymph node metastasis is considered feasible and efficacious in improving the survival and prognosis. It is critical to characterize lymph node preoperatively. There is currently no consensus regarding the optimal method for the assessment of regional lymph nodes in patients with HCC.
AIM To evaluate the diagnostic value of single source dual energy computed tomography (CT) in regional lymph node assessment for HCC patients.
METHODS Forty-three patients with pathologically confirmed HCC who underwent partial hepatectomy with lymphadenectomy were retrospectively enrolled. All patients underwent dual-energy CT preoperatively. Regional lymph nodes (n = 156) were divided into either a metastatic (group P, n = 52) or a non-metastasis group (group N, n = 104), and further, according to pathology, divided into an active hepatitis (group P1, n = 34; group N1, n = 73) and a non-active hepatitis group (group P2, n = 18; group N2, n = 31). The maximal short axis diameter (MSAD), iodine concentration (IC), normalized IC (NIC), and the slope of the spectral curve (λHU) of each group in the arterial phase (AP), portal phase (PP), and delayed phase (DP) were analyzed.
RESULTS Analysis of the MSAD, IC, NIC, and λHU showed statistical differences between groups P and N (P < 0.05) during all three phases. To distinguish benign from metastatic lymph nodes, the diagnostic efficacy of IC, NIC, and λHU in the PP was the best among the three phases (AP, PP, and DP), with a sensitivity up to 81.9%, 83.9%, and 81.8%, and a specificity up to 82.4%, 84.1% and 84.1%, respectively. The diagnostic value of combined analyses of MSAD with IC, NIC, or λHU in the PP was superior to the dual energy CT parameters alone, with a sensitivity up to 84.5%, 86.9%, and 86.2%, and a specificity up to 83.0%, 93.6% and 89.8%, respectively. Between groups P1 and P2 and groups N1 and N2, only IC, NIC, and λHU between groups N1 and N2 in the PP had a statistically significant difference (P < 0.05).
CONCLUSION Dual-energy CT contributes beneficially to regional lymph node assessment in HCC patients. Combination of MSAD with IC, NIC, or λHU values in the PP is superior to using any single parameter alone. Active hepatitis does not deteriorate the capabilities for characterization of metastatic lymph nodes.
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Affiliation(s)
- Yu-Rong Zeng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
| | - Qi-Hua Yang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
| | - Qing-Yu Liu
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
| | - Jun Min
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
| | - Hai-Gang Li
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
| | - Zhi-Feng Liu
- Department of Radiology, Zengcheng District People’s Hospital of Guangzhou, Guangzhou 511300, Guangdong Province, China
| | - Ji-Xin Li
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
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Refaat R, Basha MAA, Hassan MS, Hussein RS, El Sammak AA, El Sammak DAEA, Radwan MHS, Awad NM, Saad El-Din SA, Elkholy E, Ibrahim DRD, Saleh SA, Montasser IF, Said H. Efficacy of contrast-enhanced FDG PET/CT in patients awaiting liver transplantation with rising alpha-fetoprotein after bridge therapy of hepatocellular carcinoma. Eur Radiol 2018; 28:5356-5367. [DOI: https:/doi.org/10.1007/s00330-018-5425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 08/30/2023]
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14
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Refaat R, Basha MAA, Hassan MS, Hussein RS, El Sammak AA, El Sammak DAEA, Radwan MHS, Awad NM, Saad El-Din SA, Elkholy E, Ibrahim DRD, Saleh SA, Montasser IF, Said H. Efficacy of contrast-enhanced FDG PET/CT in patients awaiting liver transplantation with rising alpha-fetoprotein after bridge therapy of hepatocellular carcinoma. Eur Radiol 2018; 28:5356-5367. [PMID: 29948070 DOI: 10.1007/s00330-018-5425-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the diagnostic accuracy and illustrate positive findings of contrast-enhanced fluorine-18 fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) image in patients awaiting liver transplantation (LT) with rising alpha-fetoprotein (AFP) after bridge therapy of hepatocellular carcinoma (HCC). MATERIALS AND METHODS This prospective study included 100 patients who were waiting for LT and who previously underwent locoregional therapy (LRT) of HCC. These patients had rising AFP levels on a routine follow-up examination awaiting LT. All patients underwent a contrast-enhanced 18F-FDG PET/CT examination. We calculated for each patient the maximum standardised uptake value (SUVmax) of the tumour and the ratio of the tumoral SUVmax to the normal-liver SUVmax. The diagnostic accuracy and positive contrast-enhanced findings of 18F-FDG PET/CT were established by histopathology and clinical and imaging follow-up as the reference standards. RESULTS Contrast-enhanced 18F-FDG PET/CT detected tumour relapse in 78 patients (13 patients had intrahepatic lesions, 10 patients had extrahepatic metastases and 55 patients with combined lesions). The sensitivity, specificity and accuracy values of contrast-enhanced 18F-FDG PET/CT examination in the detection of HCC recurrence were 92.8%, 94.1% and 93%, respectively. A significant correlation was found between the AFP level and SUVmax ratio (r = 0.2283; p = 0.0224). The best threshold for 18F-FDG PET positivity was >1.21. CONCLUSION Contrast-enhanced 18F-FDG PET/CT is a valuable tool for the detection of intrahepatic HCC recurrence or extrahepatic metastasis following rising AFP levels after LRT of HCC, and should be incorporated during routine workup awaiting LT. KEY POINTS • 18F-FDG PET/CT is a valuable tool for the detection of HCC recurrence • 18 F-FDG PET/CT should be incorporated during routine workup awaiting liver transplantation • Significant correlation was found between AFP level and SUVmax ratio • The best threshold for 18 F-FDG PET positivity was >1.21 • The ideal cut-off value for AFP was >202.
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Affiliation(s)
- Rania Refaat
- Department of Radiodiagnosis, Ain Shams University, Cairo, Egypt
| | | | | | - Rasha S Hussein
- Department of Radiodiagnosis, Ain Shams University, Cairo, Egypt
| | | | | | | | - Nahla M Awad
- Early Cancer Detection Unit, Ain Shams University Hospitals, Cairo, Egypt
| | | | - Engi Elkholy
- Department of Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Dina R D Ibrahim
- Department of Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Shereen A Saleh
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Ain Shams University, Cairo, Egypt
| | - Iman F Montasser
- Department of Tropical Medicine, HCC Unit, Ain Shams University, Cairo, Egypt
| | - Hany Said
- Department of General Surgery HPB, and Liver Transplantation, Ain Shams Center for Organ Transplantation, Ain Shams University, Cairo, Egypt
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15
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Kim JM, Kwon CHD, Joh JW, Sinn DH, Choi GS, Paik SW. Prognosis of preoperative positron emission tomography uptake in hepatectomy patients. Ann Surg Treat Res 2018; 94:183-189. [PMID: 29629352 PMCID: PMC5880975 DOI: 10.4174/astr.2018.94.4.183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/06/2017] [Accepted: 08/22/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose Preoperative F-18-fluoro-2-deoxy-glucose positron emission tomography (18F-FDG PET) imaging results appear to predict tumor recurrence and patient survival. The present study compared outcomes between PET-positive and PET-negative groups with HBV-related hepatocellular carcinoma (HCC) who underwent curative hepatectomy and assessed the prognostic value of positive PET-CT for HCC recurrence and death. Methods This study included patients who underwent liver resection of solitary HCC between 2007 and 2014 based on preoperative radiological images. There were 133 patients in the PET-positive group and 93 in the PET-negative group. Results There were no statistically significant differences in baseline, perioperative, or pathologic characteristics between the 2 groups except HBsAg titer, tumor size, and presence of bile duct tumor thrombi. Multivariate analysis showed that tumor size >3.5 cm and HBsAg titer >1,000 cutoff index were predisposing factors of positive PET-CT. Disease-free survival and overall survival rate at 1, 3, and 5 years were 76.3%, 64.4%, 60.3% and 96.8%, 91.1%, 85.1% in the PET-negative group, respectively, compared with 70.7%, 62.2%, 58.9% and 98.5%, 97.0%, 97.0% in the PET-positive group (P = 0.547 and P = 0.046). Multivariate analysis showed that positive PET-CT was closely associated with increased patient survival, but was not related to HCC recurrence. Conclusion These results suggest that positive PET findings are not a predisposing factor for recurrence of HBV-related HCC patients, but appear to be associated with improved patient survival. Further prospective studies are needed to confirm the prognostic value of 18F-FDG PET in these patients.
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Affiliation(s)
- Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woon Paik
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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She WH, Chan ACY, Cheung TT, Lo CM, Chok KSH. Survival outcomes of liver transplantation for hepatocellular carcinoma in patients with normal, high and very high preoperative alpha-fetoprotein levels. World J Hepatol 2018; 10:308-318. [PMID: 29527266 PMCID: PMC5838449 DOI: 10.4254/wjh.v10.i2.308] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/18/2017] [Accepted: 02/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the impact of alpha-fetoprotein (AFP) on long-term recurrence rate and overall survival and we also aimed to define the level of AFP leading to a higher risk of disease recurrence and affecting patient survival.
METHODS Data of adult patients who received liver transplant (LT) for hepatocellular carcinoma (HCC) at our hospital from January 2000 to December 2013 were reviewed. Reviewed data included demographic characteristics, preoperative AFP level, operative details, follow-up details, and survival outcomes. Patients were mostly listed for LT based on Milan or UCSF criteria. For the purpose of this study, normal AFP level was defined as AFP value < 10 ng/mL, high AFP level was defined as AFP value ≥ 10 to < 400 ng/mL, and very high AFP level was defined as AFP ≥ 400 ng/mL. The patients were divided into these 3 groups accordingly. Survival rates were plotted as Kaplan-Meier curves and compared by log-rank analysis. Continuous variables were expressed as median (interquartile range). Categorical variables were compared by Spearman’s test. Discriminative analysis was used to define the lowest value of AFP that could affect the overall survival in study population. Statistical significance was defined by a P value of < 0.05.
RESULTS Totally 250 adult patients underwent LT for HCC in the study period. Eight-four of them received deceased-donor LT and 166 had living-donor LT. The patients were divided into 3 groups: Group A, AFP < 10 ng/mL (n = 83); Group B, AFP ≥ 10 to < 400 ng/mL (n = 131); Group C, AFP ≥ 400 ng/mL (n = 36). The commonest etiology was hepatitis-B-related cirrhosis. The Model for End-stage Liver Disease scores in these groups were similar (median, 13 vs 13 vs 12; P = 0.745). The time to operation in Group A was longer (median, 94 vs 31 vs 35 d; P = 0.001). The groups were similar in hospital mortality (P = 0.626) and postoperative complication (P = 0.702). Pathology of explants showed that the 3 groups had similar numbers of tumor nodules, but the tumors in Group C were larger (A: 2.5 cm, B: 3.0 cm, C: 4.0 cm; P = 0.003). Group C had a bigger proportion of patients who were beyond Milan criteria (P = 0.010). Poor differentiation and vascular permeation were also more common in this group (P = 0.017 and P = 0.003 respectively). It also had poorer 5-year survival (A: 85.5%, B: 82.4%, C: 66%; P = 0.029). The 5-year disease-free survival was 84.3% in Group A, 80.1% in Group B, and 61.1% in Group C. Receiver operating characteristic area under the curve for AFP in predicting tumor recurrence was 0.685. The selected cut-off value was 54 ng/mL for AFP (C-index 0.685; 95%CI: 0.592-0.779; sensitivity 0.595; specificity 0.687). On discriminative analysis, AFP value of 105 ng/mL was shown to affect the overall survival of the patients.
CONCLUSION HCC patients with a high preoperative AFP level had inferior survival after LT. AFP level of 54 ng/mL was associated with disease recurrence, and AFP level of 105 ng/mL was found to be the cut-off value for overall survival difference.
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Affiliation(s)
- Wong Hoi She
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - Albert Chi Yan Chan
- Department of Surgery and State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery and State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
| | - Chung Mau Lo
- Department of Surgery and State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
| | - Kenneth Siu Ho Chok
- Department of Surgery and State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong, China
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Blanc-Durand P, Van Der Gucht A, Jreige M, Nicod-Lalonde M, Silva-Monteiro M, Prior JO, Denys A, Depeursinge A, Schaefer N. Signature of survival: a 18F-FDG PET based whole-liver radiomic analysis predicts survival after 90Y-TARE for hepatocellular carcinoma. Oncotarget 2017; 9:4549-4558. [PMID: 29435123 PMCID: PMC5796994 DOI: 10.18632/oncotarget.23423] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose To generate a predictive whole-liver radiomics scoring system for progression-free survival (PFS) and overall survival (OS) in patients undergoing transarterial radioembolization using Yttrium-90 (90Y-TARE) for unresectable hepatocellular carcinoma (uHCC). Results The generated pPET-RadScores were significantly correlated with survival for PFS (median of 11.4 mo [95% confidence interval CI: 6.3–16.5 mo] in low-risk group [PFS-pPET-RadScore < 0.09] vs. 4.0 mo [95% CI: 2.3–5.7 mo] in high-risk group [PFS-pPET-RadScore > 0.09]; P = 0.0004) and OS (median of 20.3 mo [95% CI: 5.7–35 mo] in low-risk group [OS-pPET-RadScore < 0.11] vs. 7.7 mo [95% CI: 6.0–9.5 mo] in high-risk group [OS-pPET-RadScore > 0.11]; P = 0.007). The multivariate analysis confirmed PFS-pPET-RadScore (P = 0.006) and OS-pPET-RadScore (P = 0.001) as independent negative predictors. Conclusion Pretreatment 18F-FDG PET whole-liver radiomics signature appears as an independent negative predictor for PFS and OS in patients undergoing 90Y-TARE for uHCC. Methods Pretreatment 18F-FDG PET of 47 consecutive patients undergoing 90Y-TARE for uHCC (31 resin spheres, 16 glass spheres) were retrospectively analyzed. For each patient, based on PET radiomics signature from whole-liver semi-automatic segmentation, PFS and OS predictive PET-radiomics scores (pPET-RadScores) were obtained using LASSO Cox regression. Using X-tile software, the optimal score to predict PFS (PFS-pPET-RadScore) and OS (OS-pPET-RadScore) served as cutoff to separate high and low-risk patients. Survival curves were estimated using the Kaplan-Meier method. The prognostic value of PFS and OS-pPET-RadScore, Barcelona-Clinic Liver Cancer staging system and serum alpha-fetoprotein level was analyzed to predict PFS and OS in multivariate analysis.
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Affiliation(s)
- Paul Blanc-Durand
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Axel Van Der Gucht
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Nicod-Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Marina Silva-Monteiro
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Adrien Depeursinge
- Institute of Information Systems, University of Applied Sciences Western Switzerland [HES-SO], Sierre, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
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18
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Wang X, Su Z, Lyu T, Figini M, Procissi D, Shangguan J, Sun C, Wang B, Shang N, Gu S, Ma Q, Gordon AC, Lin K, Wang J, Lewandowski RJ, Salem R, Yaghmai V, Larson AC, Zhang Z. 18F-FDG PET Biomarkers Help Detect Early Metabolic Response to Irreversible Electroporation and Predict Therapeutic Outcomes in a Rat Liver Tumor Model. Radiology 2017; 287:137-145. [PMID: 29232185 DOI: 10.1148/radiol.2017170920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To test the hypothesis that biomarkers of fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used for the early detection of therapeutic response to irreversible electroporation (IRE) of liver tumor in a rodent liver tumor model. Materials and Methods The institutional animal care and use committee approved this study. Rats were inoculated with McA-RH7777 liver tumor cells in the left median and left lateral lobes. Tumors were allowed to grow for 7 days to reach a size typically at least 5 mm in longest diameter, as verified with magnetic resonance (MR) imaging. IRE electrodes were inserted, and eight 100-μsec, 2000-V pulses were applied to ablate the tumor tissue in the left median lobe. Tumor in the left lateral lobe served as a control in each animal. PET/computed tomography (CT) and MR imaging measurements were performed at baseline and 3 days after IRE for each animal. Additional MR imaging measurements were obtained 14 days after IRE. After 14-day follow-up MR imaging, rats were euthanized and tumors harvested for hematoxylin-eosin, CD34, and caspase-3 staining. Change in the maximum standardized uptake value (ΔSUVmax) was calculated 3 days after IRE. The maximum lesion diameter change (ΔDmax) was measured 14 days after IRE by using axial T2-weighted imaging. ΔSUVmax and ΔDmax were compared. The apoptosis index was calculated by using caspase-3-stained slices of apoptotic tumor cells. Pearson correlation coefficients were calculated to assess the relationship between ΔSUVmax at 3 days and ΔDmax (or apoptosis index) at 14 days after IRE treatment. Results ΔSUVmax, ΔDmax, and apoptosis index significantly differed between treated and untreated tumors (P < .001 for all). In treated tumors, there was a strong correlation between ΔSUVmax 3 days after IRE and ΔDmax 14 days after IRE (R = 0.66, P = .01) and between ΔSUVmax 3 days after IRE and apoptosis index 14 days after IRE (R = 0.57, P = .04). Conclusion 18F-FDG PET imaging biomarkers can be used for the early detection of therapeutic response to IRE treatment of liver tumors in a rodent model. © RSNA, 2017.
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Affiliation(s)
- Xifu Wang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Zhanliang Su
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Tianchu Lyu
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Matteo Figini
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Daniel Procissi
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Junjie Shangguan
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Chong Sun
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Bin Wang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Na Shang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Shanzhi Gu
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Quanhong Ma
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Andrew C Gordon
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Kai Lin
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Jian Wang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Robert J Lewandowski
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Riad Salem
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Vahid Yaghmai
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Andrew C Larson
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Zhuoli Zhang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
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Refining the management of patients with hepatocellular carcinoma integrating 11C-choline PET/CT scan into the multidisciplinary team discussion. Nucl Med Commun 2017; 38:826-836. [DOI: 10.1097/mnm.0000000000000719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Cascales-Campos PA, Romero PR, Schneider MA, Lopez-Lopez V, Navarro JL, Frutos L, Pons Miñano JA, Paricio PP. Positron emission tomography/computed tomography in patients with hepatocellular carcinoma undergoing liver transplantation. Useful, necessary or irrelevant? Eur J Radiol 2017. [DOI: 10.1016/j.ejrad.2017.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Jreige M, Mitsakis P, Van Der Gucht A, Pomoni A, Silva-Monteiro M, Gnesin S, Boubaker A, Nicod-Lalonde M, Duran R, Prior JO, Denys A, Schaefer N. 18F-FDG PET/CT predicts survival after 90Y transarterial radioembolization in unresectable hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2017; 44:1215-1222. [PMID: 28233086 DOI: 10.1007/s00259-017-3653-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/08/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the value of pretreatment functional and morphological imaging parameters for predicting survival in patients undergoing transarterial radioembolization using yttrium-90 (90Y-TARE) for unresectable hepatocellular carcinoma (uHCC). METHODS We analysed data from 48 patients in our prospective database undergoing 90Y-TARE treatment for uHCC (31 resin, 17 glass). All patients underwent 18F-FDG PET/CT and morphological imaging (CT and MRI scans) as part of a pretherapeutic work-up. Patients did not receive any treatment between these imaging procedures and 90Y-TARE. Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) were used to assess the prognostic value of 18F-FDG PET/CT metabolic parameters, including SUVmax, tumour-to-liver (T/L) uptake ratio and SUVmean of healthy liver, and morphological data, including number and size of lesions, portal-venous infiltration (PVI). Relevant prognostic factors for HCC including Child-Pugh class, Barcelona Clinic Liver Cancer (BCLC) stage, tumour size, PVI and serum AFP level were compared with metabolic parameters in univariate and multivariate analyses. RESULTS The median follow-up in living patients was 16.2 months (range 11.4-50.1 months). Relapse occurred in 34 patients (70.8%) at a median of 7.4 months (range 1.4-27.9 months) after 90Y-TARE, and relapse occurred in 24 of 34 patients (70.8%) who died from their disease at a median of 8.1 months (range 2.2-35.2 months). Significant prognostic markers for PFS were the mean and median lesion SUVmax (both P = 0.01; median PFS 10.2 vs. 7.4 months), and significant prognostic markers for OS were the first quarter (Q1) cut-off values for lesion SUVmax and T/L uptake ratio (both P = 0.02; median OS 30.9 vs. 9 months). The multivariate analysis confirmed that lesion SUVmax and T/L uptake ratio were independent negative predictors of PFS (hazard ratio, HR, 2.7, 95% CI 1.2-6.1, P = 0.02, for mean SUVmax; HR 2.6, 95% CI 1.1-5.9, P = 0.02, for median SUVmax:) and OS (HR 3.2, 95% CI 1-10.9, P = 0.04 for Q1 SUVmax; HR 3.7, 95% CI 1.1-12.2, P = 0.03, for Q1 T/L uptake ratio), respectively, when testing with either the BCLC staging system or serum AFP level. CONCLUSION Lesion SUVmax and T/L uptake ratio as assessed by 18F-FDG PET/CT, but not morphological imaging, were predictive markers of survival in patients undergoing 90Y-TARE for uHCC.
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Affiliation(s)
- Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Periklis Mitsakis
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Axel Van Der Gucht
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Anastasia Pomoni
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Marina Silva-Monteiro
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Ariane Boubaker
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Marie Nicod-Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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Abuodeh Y, Naghavi AO, Ahmed KA, Venkat PS, Kim Y, Kis B, Choi J, Biebel B, Sweeney J, Anaya DA, Kim R, Malafa M, Frakes JM, Hoffe SE, El-Haddad G. Prognostic value of pre-treatment F-18-FDG PET-CT in patients with hepatocellular carcinoma undergoing radioembolization. World J Gastroenterol 2016; 22:10406-10414. [PMID: 28058021 PMCID: PMC5175253 DOI: 10.3748/wjg.v22.i47.10406] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/15/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the value of pre-treatment 18F-FDG PET/CT in patients with HCC following liver radioembolization. METHODS We identified 34 patients with HCC who underwent an FDG PET/CT scan prior to hepatic radioembolization at our institution between 2009 and 2013. Patients were seen in clinic one month after radioembolization and then at 2-3 mo intervals. We assessed the influence of FDG tumor uptake on outcomes including local liver control (LLC), distant liver control (DLC), time to distant metastases (DM), progression free survival (PFS) and overall survival (OS). RESULTS The majority of patients were males (n = 25, 74%), and had Child Pugh Class A (n = 31, 91%), with a median age of 68 years (46-84 years). FDG-avid disease was found in 19 (56%) patients with SUVmax ranging from 3 to 20. Female patients were more likely to have an FDG-avid HCC (P = 0.02). Median follow up of patients following radioembolization was 12 months (1.2-62.8 mo). FDG-avid disease was associated with a decreased 1 year LLC, DLC, DM and PFS (P < 0.05). Using multivariate analysis, FDG avidity predicted for LLC, DLC, and PFS (all P < 0.05). CONCLUSION In this retrospective study, pre-treatment HCC FDG-avidity was found to be associated with worse LLC, DLC, and PFS following radioembolization. Larger studies are needed to validate our initial findings to assess the role of F-18-FDG PET/CT scans as biomarker for patients with HCC following radioembolization.
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Shang RZ, Qu SB, Wang DS. Reprogramming of glucose metabolism in hepatocellular carcinoma: Progress and prospects. World J Gastroenterol 2016; 22:9933-9943. [PMID: 28018100 PMCID: PMC5143760 DOI: 10.3748/wjg.v22.i45.9933] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/30/2016] [Accepted: 11/13/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most lethal cancers, and its rate of incidence is rising annually. Despite the progress in diagnosis and treatment, the overall prognoses of HCC patients remain dismal due to the difficulties in early diagnosis and the high level of tumor invasion, metastasis and recurrence. It is urgent to explore the underlying mechanism of HCC carcinogenesis and progression to find out the specific biomarkers for HCC early diagnosis and the promising target for HCC chemotherapy. Recently, the reprogramming of cancer metabolism has been identified as a hallmark of cancer. The shift from the oxidative phosphorylation metabolic pathway to the glycolysis pathway in HCC meets the demands of rapid cell proliferation and offers a favorable microenvironment for tumor progression. Such metabolic reprogramming could be considered as a critical link between the different HCC genotypes and phenotypes. The regulation of metabolic reprogramming in cancer is complex and may occur via genetic mutations and epigenetic modulations including oncogenes, tumor suppressor genes, signaling pathways, noncoding RNAs, and glycolytic enzymes etc. Understanding the regulatory mechanisms of glycolysis in HCC may enrich our knowledge of hepatocellular carcinogenesis and provide important foundations in the search for novel diagnostic biomarkers and promising therapeutic targets for HCC.
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Fat-Containing Hypermetabolic Masses on FDG PET/CT: A Spectrum of Benign and Malignant Conditions. AJR Am J Roentgenol 2016; 207:1095-1104. [PMID: 27490138 DOI: 10.2214/ajr.16.16066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This article focuses on identifying the imaging appearances of hypermetabolic fatty masses and masslike lesions on PET/CT and understanding the diagnostic challenges radiologists may face while interpreting findings of these lesions on PET/CT. This article provides an approach to aid in the diagnosis of these lesions and the appropriate management of patients. CONCLUSION Both malignant and benign fat-containing masses and masslike lesions can show hypermetabolic activity on PET/CT. Although the differential diagnosis is broad, clinical history, anatomic location, and knowledge of anatomic variants and imaging features can help radiologists avoid misinterpretation of benign fatty lesions as malignancy.
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Abstract
PURPOSE Although intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy after hepatocellular carcinoma, there are limited data available on PET/CT imaging in ICC. This retrospective study analyzed the role of PET/CT imaging in the evaluation of ICC. METHODS FDG PET/CT findings were reviewed in 65 patients with histologically confirmed ICC. PET/CT was evaluated based on visual interpretation and the semiquantitative index of SUVmax and tumor-to-normal liver tissue ratio (TNR), which were consequently further analyzed and correlated with tumor localization, differentiation, size, and serum levels of tumor markers. Forty-five cases also underwent abdominal MRI examinations. RESULTS Nineteen patients had hilar ICC, whereas 46 patients had peripheral ICC. Sixty cases of ICC showed elevated FDG uptake with an average SUVmax of 8.3 ± 4.7 and TNR of 3.1 ± 1.7. Five cases located in the hilum were false negative on PET/CT imaging. Compared with hilar ICC, SUVmax and TNR of peripheral ICC were significantly higher (P < 0.05). FDG accumulation correlated with the degree of ICC differentiation. SUVmax and TNR correlated with tumor size, whereas there was no correlation observed with serum levels of carbohydrate antigen 19-9. The sensitivity, specificity, and accuracy of PET/CT and MRI in the diagnosis of regional lymph node metastases were 70.0% versus 50%, 91.7% versus 83.3%, and 81.8% versus 68.2%, respectively. PET/CT upstaged 12.3% and downstaged 3.1% of cases and had no impact on patient management in the remaining 84.6% of cases. CONCLUSIONS Combination of FDG PET/CT and abdominal MRI might improve the diagnostic accuracy for ICC.
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Hyun SH, Eo JS, Lee JW, Choi JY, Lee KH, Na SJ, Hong IK, Oh JK, Chung YA, Song BI, Kim TS, Kim KS, Moon DH, Yun M. Prognostic value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with Barcelona Clinic Liver Cancer stages 0 and A hepatocellular carcinomas: a multicenter retrospective cohort study. Eur J Nucl Med Mol Imaging 2016; 43:1638-45. [PMID: 26936852 DOI: 10.1007/s00259-016-3348-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE We evaluated the prognostic value of pretreatment (18)F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A hepatocellular carcinoma (HCC) who had received curative treatment or transarterial chemoembolization (TACE). METHODS Between 2009 and 2010, 317 patients diagnosed with HCC at seven hospitals were enrolled. Among these, 195 patients underwent curative treatments including resection, liver transplantation, and radiofrequency ablation. TACE was performed in 122 patients. The tumor-to-normal liver standardized uptake value ratio (TLR) of the primary tumor was measured using pretreatment FDG PET/CT. The prognostic significance of TLR and other clinical variables was assessed using Cox regression models. Differences in the overall survival (OS) associated with TLR or other significant clinical factors were examined using the Kaplan-Meier method. RESULTS Over a median follow-up period of 46 months, 77 patients died from cancer. In the curative cohort, higher TLR (≥2) was significantly associated with death (hazard ratio [HR] = 2.68; 95 % CI, 1.16-6.15; P = 0.020) in multivariable analysis. Patients with a higher TLR had significantly worse OS than patients with a lower TLR (5-year overall survival, 61 % vs. 79.4 %; P = 0.006). In the TACE cohort, the Model for End-Stage Liver Disease (MELD) score (≥8) was a significant independent prognostic factor for OS (HR = 3.34; 95 % CI, 1.49-7.48; P = 0.003), whereas TLR was not associated with OS. The Kaplan-Meier curves showed significantly poorer OS in patients with higher MELD scores (≥8) than in those with lower MELD scores (5-year survival rate, 33.1 % vs. 79.6 %; P < 0.001). CONCLUSIONS Pretreatment TLR measured using FDG PET/CT was an independent prognostic factor for OS in patients with BCLC stage 0 or A HCC undergoing curative treatment. In contrast, underlying liver function appeared to be important in predicting the prognosis of patients undergoing TACE.
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Affiliation(s)
- Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sae Jung Na
- Department of Nuclear Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Il Ki Hong
- Department of Nuclear Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jin Kyoung Oh
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yong An Chung
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Bong-Il Song
- Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Tae-Sung Kim
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Hyuk Moon
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Mijin Yun
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Boussouar S, Itti E, Lin SJ, Decaens T, Evangelista E, Chiaradia M, Chalaye J, Baranes L, Calderaro J, Laurent A, Pigneur F, Duvoux C, Azoulay D, Costentin C, Rahmouni A, Luciani A. Functional imaging of hepatocellular carcinoma using diffusion-weighted MRI and (18)F-FDG PET/CT in patients on waiting-list for liver transplantation. Cancer Imaging 2016; 16:4. [PMID: 26883745 PMCID: PMC4756529 DOI: 10.1186/s40644-016-0062-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/02/2016] [Indexed: 02/08/2023] Open
Abstract
Background To compare the apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) with the standardized uptake values (SUV) measured by18F-FDG-PET/CT in naïve hepatocellular carcinoma (HCC) nodules, and to determine whether these markers are associated with tumours at high-risk of aggressiveness. Methods From 2007 to 2010, all patients with HCC on the waiting list for liver transplantation and who underwent both FDG-PET/CT and 1.5-T DWI-MRI (b values: 0, 200, 400, and 800 s/mm2) were included in this institutional review board-approved retrospective study. Tumour size, tumour ADC, tumour-to-liver ADC ratio (ADCT/L), maximal tumour SUV and tumour-to-liver SUV ratio (SUVT/L) were measured and compared to serum alpha-fetoprotein (AFP) levels, tumour size and differentiation grade on explanted specimens. Results A total of 37 HCC nodules in 28 patients were available for correlation between MRI and PET/CT, 7 of which (in 7 patients) showed a SUVT/L > 1.15. We did not find any correlation between tumour ADC or ADCT/L and tumour SUV or SUVT/L. To note, SUVT/L was positively correlated with AFP levels (R = 0.95, P ≤ 0.0001), while ADCT/L was not (P = 0.73). Twenty-four patients (with 32 nodules) underwent liver transplantation. In this subgroup, an increased SUVT/L ratio was associated with larger tumours (average size, 32 ± 14 mm; range, 18–60 mm; P < 0.0001) and with poor differentiation on pathology (grades 3 and 4; P = 0.04), while ADCT/L was neither associated with tumour size or differentiation grade. Conclusions ADC and SUV measures in HCC nodules are not correlated. SUVT/L ratio correlates with AFP levels, tumour size and poor differentiation, and should probably be integrated as a co-variable in a predictive outcome model of patients on the waiting-list for liver transplantation.
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Affiliation(s)
- Samia Boussouar
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France.
| | - Emmanuel Itti
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France. .,INSERM Unité U 955, GRC Amyloid Research Institute, Créteil, F-94010, France. .,Service de Médecine Nucléaire, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Créteil, Cedex, France.
| | - Shih-Jui Lin
- Biomedical Informatics, Stanford University, Stanford, CA, 94305, USA.
| | - Thomas Decaens
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Hépatologie, Créteil, F-94010, France.
| | - Eva Evangelista
- AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France.
| | - Melanie Chiaradia
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. .,Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France.
| | - Julia Chalaye
- AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France.
| | - Laurence Baranes
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France.
| | - Julien Calderaro
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Pathologie, Créteil, F-94010, France. .,INSERM Unité U 955, Equipe 18, Créteil, F-94010, France.
| | - Alexis Laurent
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,INSERM Unité U 955, Equipe 18, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Chirurgie hépatique, Créteil, F-94010, France.
| | - Frederic Pigneur
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France.
| | - Christophe Duvoux
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Hépatologie, Créteil, F-94010, France.
| | - Daniel Azoulay
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Chirurgie hépatique, Créteil, F-94010, France.
| | - Charlotte Costentin
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Hépatologie, Créteil, F-94010, France.
| | - Alain Rahmouni
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. .,Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France.
| | - Alain Luciani
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. .,Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,INSERM Unité U 955, Equipe 18, Créteil, F-94010, France.
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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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Fahrner R, Dondorf F, Ardelt M, Dittmar Y, Settmacher U, Rauchfuß F. Liver transplantation for hepatocellular carcinoma - factors influencing outcome and disease-free survival. World J Gastroenterol 2015; 21:12071-12082. [PMID: 26576092 PMCID: PMC4641125 DOI: 10.3748/wjg.v21.i42.12071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma is one of the leading causes of cancer-related death worldwide. Liver transplantation can be a curative treatment in selected patients. However, there are several factors that influence disease-free survival after transplantation. This review addresses the pre-, intra- and postoperative factors that influence the risk of tumor recurrence after liver transplantation.
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30
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Jo IY, Son SH, Kim M, Sung SY, Won YK, Kang HJ, Lee SJ, Chung YA, Oh JK, Kay CS. Prognostic value of pretreatment (18)F-FDG PET-CT in radiotherapy for patients with hepatocellular carcinoma. Radiat Oncol J 2015; 33:179-87. [PMID: 26484301 PMCID: PMC4607571 DOI: 10.3857/roj.2015.33.3.179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/24/2015] [Accepted: 07/27/2015] [Indexed: 12/11/2022] Open
Abstract
Purpose The purpose of this study was to investigate the predictable value of pretreatment 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) in radiotherapy (RT) for patients with hepatocellular carcinoma (HCC) or portal vein tumor thrombosis (PVTT). Materials and Methods We conducted a retrospective analysis of 36 stage I-IV HCC patients treated with RT. 18F-FDG PET-CT was performed before RT. Treatment target was determined HCC or PVTT lesions by treatment aim. They were irradiated at a median prescription dose of 50 Gy. The response was evaluated within 3 months after completion of RT using the Response Evaluation Criteria in Solid Tumors (RECIST). Response rate, overall survival (OS), and the pattern of failure (POF) were analyzed. Results The response rate was 61.1%. The statistically significant prognostic factor affecting response in RT field was maximal standardized uptake value (maxSUV) only. The high SUV group (maxSUV ≥ 5.1) showed the better radiologic response than the low SUV group (maxSUV < 5.1). The median OS were 996.0 days in definitive group and 144.0 days in palliative group. Factors affecting OS were the %reduction of alpha-fetoprotein (AFP) level in the definitive group and Child-Pugh class in the palliative group. To predict the POF, maxSUV based on the cutoff value of 5.1 was the only significant factor in distant metastasis group. Conclusion The results of this study suggest that the maxSUV of 18F-FDG PET-CT may be a prognostic factor for treatment outcome and the POF after RT. A %reduction of AFP level and Child-Pugh class could be used to predict OS in HCC.
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Affiliation(s)
- In Young Jo
- Department of Radiation Oncology, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seok-Hyun Son
- Department of Radiation Oncology, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Myungsoo Kim
- Department of Radiation Oncology, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo Yoon Sung
- Department of Radiation Oncology, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Kyun Won
- Department of Radiation Oncology, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hye Jin Kang
- Department of Radiation Oncology, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - So Jung Lee
- Department of Radiation Oncology, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong-An Chung
- Department of Radiology, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Kyoung Oh
- Department of Radiology, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chul-Seung Kay
- Department of Radiation Oncology, the Catholic University of Korea College of Medicine, Seoul, Korea
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31
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Asman Y, Evenson AR, Even-Sapir E, Shibolet O. [18F]fludeoxyglucose positron emission tomography and computed tomography as a prognostic tool before liver transplantation, resection, and loco-ablative therapies for hepatocellular carcinoma. Liver Transpl 2015; 21:572-80. [PMID: 25644857 DOI: 10.1002/lt.24083] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/08/2015] [Accepted: 01/18/2015] [Indexed: 12/19/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related death worldwide. Orthotopic liver transplantation (OLT) and resection are curative treatment options for well-selected patients with HCC, whereas loco-ablative therapy has been shown to prolong survival. Organ and treatment allocations for these patients are currently based on the number and size of tumors, as defined by the Milan criteria, and on functional capacity, and they are incorporated into the Barcelona Clinic Liver Cancer staging system and treatment strategy. Even though these staging criteria have markedly improved the outcomes of patients with HCC, they still lack accuracy in predicting the risk of tumor recurrence because they do not incorporate markers of tumor biology and behavior. Positron emission tomography (PET) and computed tomography (CT) with [(18) F]fludeoxyglucose ([(18) F]FDG) constitute an imaging modality for detecting tumor tissue that is metabolically active. Uptake of [(18) F]FDG is highly associated with tumor aggressiveness. In this review, we present the accumulating data on the use of [(18) F]FDG PET-CT as an in vivo biomarker and its predictive value in identifying patients at risk for HCC recurrence after liver transplantation, resection, or ablation. These data suggest that the introduction of [(18) F]FDG PET-CT into the imaging algorithm of patients planned for liver transplantation, resection, or ablation may improve outcomes.
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Affiliation(s)
- Yael Asman
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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32
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Parikh U, Marcus C, Sarangi R, Taghipour M, Subramaniam RM. FDG PET/CT in Pancreatic and Hepatobiliary Carcinomas: Value to Patient Management and Patient Outcomes. PET Clin 2015; 10:327-43. [PMID: 26099670 DOI: 10.1016/j.cpet.2015.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Fludeoxyglucose F 18 ((18)F-FDG) PET/CT has not been shown to offer additional benefit in the initial diagnosis of pancreatic cancer, but studies show benefit of (18)F-FDG PET/CT in initial staging and patient prognosis. There is evidence for (18)F-FDG PET and (18)F-FDG PET/CT in staging and prognosis of cholangiocarcinoma and gallbladder cancer. (18)F-FDG PET/CT has shown promise in staging liver malignancies by detecting extrahepatic metastasis. There is evidence supporting the ability of PET/CT in predicting prognosis in patients with hepatocellular carcinoma. Evidence is evolving for the role of (18)F-FDGPET/CT in predicting prognosis and survival in patients with colorectal liver metastasis.
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Affiliation(s)
- Ujas Parikh
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Charles Marcus
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Rutuparna Sarangi
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Mehdi Taghipour
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Rathan M Subramaniam
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA; Department of Oncology, Johns Hopkins School of Medicine, 401 North Broadway, Baltimore, MD 21231, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
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33
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Detry O, Govaerts L, Deroover A, Vandermeulen M, Meurisse N, Malenga S, Bletard N, Mbendi C, Lamproye A, Honoré P, Meunier P, Delwaide J, Hustinx R. Prognostic value of 18F-FDG PET/CT in liver transplantation for hepatocarcinoma. World J Gastroenterol 2015; 21:3049-3054. [PMID: 25780305 PMCID: PMC4356927 DOI: 10.3748/wjg.v21.i10.3049] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/29/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the prognostic value of pretreatment FDG positron emission tomography computed tomography (PET-CT) in patients with hepatocarcinoma treated by liver transplantation (LT).
METHODS: The authors retrospectively analyzed the data of 27 patients (mean age 58 ± 9 years) who underwent FDG PET-CT before LT for hepatocarcinoma. Mean follow-up was 26 ± 18 mo. The FDG PET/CT was performed according to a standard clinical protocol: 4 MBqFDG/kg body weight, uptake 60 min, low-dose non-enhanced CT. The authors measured the SUVmax and SUVmean of the tumor and the normal liver. The tumor/liver activity ratios (RSUVmax and RSUVmean) were tested as prognostic factors and compared to the following conventional prognostic factors: MILAN, CLIP, OKUDA, TNM stage, alphafoetoprotein level, portal thrombosis, size of the largest nodule, tumor differentiation, microvascular invasion, underlying cirrhosis and liver function.
RESULTS: Overall and recurrence free survivals were 80.7% and 67.4% at 3 years, and 70.6% and 67.4% at 5 years, respectively. According to a multivariate Cox model, only FDG PET/CT RSUVmax predicted recurrence free survival. Even though the MILAN criteria alone were not predictive, it is worth noting that none of the patients outside the MILAN criteria and with RSUVmax < 1.15 relapsed.
CONCLUSION: FDG PET/CT with an RSUVmax cut-off value of 1.15 is a strong prognostic factor for recurrence and death in patients with HCC treated by LT in this retrospective series. Further prospective studies should test whether this metabolic index should be systematically included in the preoperative assessment.
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Teixera SR, Kohan AA, Paspulati RM, Rong R, Herrmann KA. Potential Role of Positron Emission Tomography/Magnetic Resonance Imaging in Gastrointestinal and Abdominal Malignancies: Preliminary Experience. Semin Roentgenol 2014; 49:321-33. [DOI: 10.1053/j.ro.2014.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Bertagna F, Bertoli M, Bosio G, Biasiotto G, Sadeghi R, Giubbini R, Treglia G. Diagnostic role of radiolabelled choline PET or PET/CT in hepatocellular carcinoma: a systematic review and meta-analysis. Hepatol Int 2014. [PMID: 26202754 DOI: 10.1007/s12072-014-9566-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The role of fluorine-18-fluorodeoxygluose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in hepatocellular carcinoma (HCC) has not been firmly established yet and its sensitivity has been reported to be in the range of 40-60 %. Because of this relatively low sensitivity alternative tracers have been proposed. The aim of our review is to analyse the literature data on the diagnostic role of (18)F/(11)C-choline PET/CT in the evaluation of HCC. A comprehensive computer literature search of PubMed/MEDLINE, Embase and Scopus databases was conducted to find relevant published articles about the role of whole-body (18)F-choline or (11)C-choline PET or PET/CT in patients with HCC. Furthermore, a meta-analysis about the detection rate of this method in HCC was performed. Six articles were included in this systematic review and discussed. The meta-analysis of five out of six articles showed a DR of 84 % (95 % CI 79-89 %). The DR increased when poorly differentiated HCC was excluded from the analysis. Radiolabelled choline PET or PET/CT could be a valuable tool in detecting HCC and it is better than (18)F-FDG PET/CT, especially in well to moderately differentiated lesions; on the other hand, poorly differentiated and higher-stage HCC could be better evaluated with (18)F-FDG and dual tracer imaging should be considered and could be potentially useful to increase accuracy.
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Affiliation(s)
- Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Mattia Bertoli
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Giovanni Bosio
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Giorgio Biasiotto
- Biomedical Technology Department, University of Brescia, Brescia, Italy
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Kawamura E, Shiomi S, Kotani K, Kawabe J, Hagihara A, Fujii H, Uchida-Kobayashi S, Iwai S, Morikawa H, Enomoto M, Murakami Y, Tamori A, Kawada N. Positioning of 18F-fluorodeoxyglucose-positron emission tomography imaging in the management algorithm of hepatocellular carcinoma. J Gastroenterol Hepatol 2014; 29:1722-7. [PMID: 24730671 DOI: 10.1111/jgh.12611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM (18) F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) may detect primary lesions (PLs) and extrahepatic metastases (EHMs) only in advanced hepatocellular carcinoma (HCC) patients. We investigated the requirement of PET and the optimal timing of PET scanning for accurate staging and treatment planning. METHODS We conducted a retrospective investigation of 64 HCC patients who underwent PET (median age, 74 years; male/female, 41/23; etiology, 46 hepatitis C virus/4 hepatitis B virus/4 alcoholic/10 others). To determine the best timing for PET examinations, we analyzed PET result-based recommended treatment changes and characteristics of patients with FDG-avid PLs or EHMs. RESULTS FDG-avid PLs were detected by PET in 22 patients (34%): 18 with hypervascular PL, 11 with serum α-fetoprotein levels ≥ 200 ng/mL, and 11 beyond Milan criteria. EHMs were detected in 21 patients (33%: lymph nodes, 8; lung, 5; abdominal wall, 4; bone, 3; other organs, 4 [including overlapping]). Recommended treatments changed for 16 patients (25%) because of Barcelona Clinic Liver Cancer stage increases based on PET scanning. In multivariate analyses, serum α-fetoprotein levels ≥ 200 ng/mL and beyond Milan criteria were independent factors for FDG-avid PLs and a maximum standardized uptake value (SUVmax) of PLs of ≥ 4.0 was an independent factor for FDG-avid EHMs (P = 0.002, 0.008, and 0.045, respectively). CONCLUSIONS PET allows detection of HCC spread in patients with elevated serum α-fetoprotein levels or those beyond Milan criteria and detects EHMs in patients with PLs with high SUVmax values. Optimally timed PET scans can complement conventional imaging for accurate staging and treatment strategy determination.
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Affiliation(s)
- Etsushi Kawamura
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Nguyen LH, Robinton DA, Seligson MT, Wu L, Li L, Rakheja D, Comerford SA, Ramezani S, Sun X, Parikh MS, Yang EH, Powers JT, Shinoda G, Shah SP, Hammer RE, Daley GQ, Zhu H. Lin28b is sufficient to drive liver cancer and necessary for its maintenance in murine models. Cancer Cell 2014; 26:248-61. [PMID: 25117712 PMCID: PMC4145706 DOI: 10.1016/j.ccr.2014.06.018] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 03/18/2014] [Accepted: 06/23/2014] [Indexed: 01/19/2023]
Abstract
Lin28a/b are RNA-binding proteins that influence stem cell maintenance, metabolism, and oncogenesis. Poorly differentiated, aggressive cancers often overexpress Lin28, but its role in tumor initiation or maintenance has not been definitively addressed. We report that LIN28B overexpression is sufficient to initiate hepatoblastoma and hepatocellular carcinoma in murine models. We also detected Lin28b overexpression in MYC-driven hepatoblastomas, and liver-specific deletion of Lin28a/b reduced tumor burden, extended latency, and prolonged survival. Both intravenous siRNA against Lin28b and conditional Lin28b deletion reduced tumor burden and prolonged survival. Igf2bp proteins are upregulated, and Igf2bp3 is required in the context of LIN28B overexpression to promote growth. Therefore, multiple murine models demonstrate that Lin28b is both sufficient to initiate liver cancer and necessary for its maintenance.
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Affiliation(s)
- Liem H Nguyen
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Daisy A Robinton
- Division of Pediatric Hematology/Oncology, Children's Hospital Boston, Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Marc T Seligson
- Division of Pediatric Hematology/Oncology, Children's Hospital Boston, Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Linwei Wu
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Lin Li
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Dinesh Rakheja
- Departments of Pathology and Pediatrics, Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Sarah A Comerford
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Saleh Ramezani
- Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Xiankai Sun
- Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Monisha S Parikh
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Erin H Yang
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - John T Powers
- Division of Pediatric Hematology/Oncology, Children's Hospital Boston, Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Gen Shinoda
- Division of Pediatric Hematology/Oncology, Children's Hospital Boston, Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Samar P Shah
- Division of Pediatric Hematology/Oncology, Children's Hospital Boston, Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Robert E Hammer
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - George Q Daley
- Division of Pediatric Hematology/Oncology, Children's Hospital Boston, Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA.
| | - Hao Zhu
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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Simoneau E, Hassanain M, Madkhali A, Salman A, Nudo CG, Chaudhury P, Metrakos P. (18)F-Fluorodeoxyglucose positron-emission tomography could have a prognostic role in patients with advanced hepatocellular carcinoma. ACTA ACUST UNITED AC 2014; 21:e551-6. [PMID: 25089106 DOI: 10.3747/co.21.1959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION We set out to evaluate the prognostic value of (18)F-fluorodeoxyglucose positron-emission tomography (pet) in patients with advanced (non-transplant-eligible) hepatocellular carcinoma (hcc) and to evaluate the correlation between standardized uptake values (suvs) and survival outcomes. METHODS We identified patients with hcc who, from 2005 to 2013, underwent pet imaging before any treatment. This retrospective study from our hcc database obtained complete follow-up data for the 63 identified patients. RESULTS Of the 63 patients, 10 underwent surgical resection, and 59 underwent locoregional therapy. In this cohort, 28 patients were pet-positive (defined as any lesion with a suv ≥ 4.0) before any therapy was given, and 35 patients were pet negative (all lesions with a suv < 4.0). On survival analysis, median survival was greater for the pet-negative than for the pet-positive patients: 29 months (range: 16.3-41.1 months) versus 12 months (range: 4.0-22.1 months) respectively, p = 0.0241. The pet-positive patients more often had large tumours (≥5 cm), poor differentiation, and extrahepatic disease, reflecting more aggressive tumours. On multivariate analysis, only pet positivity was associated with poor survival (p = 0.049). CONCLUSIONS Compared with pet-positive patients, pet-negative patients with hcc experienced longer survival. Imaging by pet can be of value in early prognostication for patients with hcc, especially patients receiving locoregional therapy for whom pathologic tumour differentiation is rarely available. This potential role for pet requires further validation in a prospective study.
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Affiliation(s)
- E Simoneau
- Department of Surgery, McGill University Health Centre, Hepatopancreaticobiliary Research Unit, Montreal, QC
| | - M Hassanain
- Department of Oncology, McGill University Health Centre, Montreal, QC. ; Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A Madkhali
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A Salman
- Department of Surgery, McGill University Health Centre, Hepatopancreaticobiliary Research Unit, Montreal, QC
| | - C G Nudo
- Department of Gastroenterology, Division of Hepatology, McGill University Health Centre, Montreal, QC
| | - P Chaudhury
- Department of Surgery, McGill University Health Centre, Hepatopancreaticobiliary Research Unit, Montreal, QC. ; Department of Oncology, McGill University Health Centre, Montreal, QC
| | - P Metrakos
- Department of Surgery, McGill University Health Centre, Hepatopancreaticobiliary Research Unit, Montreal, QC. ; Departments of Pathology and Anatomy and Cell Biology, McGill University Health Centre, Montreal, QC
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Eo JS, Paeng JC, Lee DS. Nuclear imaging for functional evaluation and theragnosis in liver malignancy and transplantation. World J Gastroenterol 2014; 20:5375-5388. [PMID: 24833867 PMCID: PMC4017052 DOI: 10.3748/wjg.v20.i18.5375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 10/23/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
Currently, nuclear imaging such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) is increasingly used in the management of liver malignancy. 18F-fluorodeoxyglucose (FDG)-PET is the most widely used nuclear imaging in liver malignancy as in other cancers, and has been reported to be effective in diagnosis, response monitoring, recurrence evaluation, and prognosis prediction. Other PET imaging such as 11C-acetate PET is also used complementarily to FDG-PET in diagnosis of liver malignancy. Additionally, image-based evaluation of regional hepatic function can be performed using nuclear imaging. Those imaging modalities are also effective for candidate selection, treatment planning, and perioperative evaluation in liver surgery and transplantation. Recently, nuclear imaging has been actively adopted in the transarterial radioembolization therapy of liver malignancy, according to the concept of theragnosis. With the development of new hybrid imaging technologies such as PET/magnetic resonance imaging and SPECT/CT, nuclear imaging is expected to be more useful in the management of liver malignancy, particularly regarding liver surgery and transplantation. In this review, the efficacy and roles of nuclear imaging methods in diagnosis, transplantation and theragnosis are discussed.
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Yang C, Yun Q, Sun H, Yang G, Liang T, Zhang C, Song J, Han J, Hou G. Non-invasive imaging of Toll-like receptor 5 expression using 131I-labeled mAb in the mice bearing H22 tumors. Oncol Lett 2014; 7:1919-1924. [PMID: 24932259 PMCID: PMC4049746 DOI: 10.3892/ol.2014.2025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/21/2014] [Indexed: 01/07/2023] Open
Abstract
Toll-like receptor 5 (TLR5) is overexpressed in several cancers and metastases, and presents an enticing target for molecular imaging of primary tumors. In the present study, 131I-anti-TLR5 monoclonal antibody (mAb) was evaluated for its use as a novel radiotracer for imaging hepatocarcinoma in mice bearing H22 tumors. The expression of TLR5 was analyzed by quantitative polymerase chain reaction and immunohistochemistry. The anti-TLR5 mAb and isotype immunoglobulin G (IgG) were radiolabeled with iodine-131 by the Iodogen method. The in vitro stability of iodinalized probes was determined in serum or saline for a series of times, and then evaluated with radio-thin-layer chromatography. The biodistribution study and autoradiography were performed in H22 tumor-bearing mice. It was found that H22-xenografted tumor tissue exhibited a higher level of TLR5 expression compared with normal liver tissues. 131I-anti-TLR5 mAb and 131I-IgG were obtained subsequent to purification, with high radiochemical purity (>95%), and remained stable for 48 h in human serum. The target-to-non-target ratio in the 131I-anti-TLR5 mAb group was significantly higher compared with the 131I-IgG group. The biodistribution study and autoradiography demonstrated that 131I-anti-TLR5 mAb was specifically retained in hepatocarcinoma with a high tumor uptake. Altogether, these results show that 131I-anti-TLR5 mAb is capable of detecting lesions in a TLR5-expressing tumor, with high target selectivity, and may offer a promising agent for hepatocarcinoma diagnosis and encourage further investigation.
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Affiliation(s)
- Changya Yang
- Key Laboratory for Experimental Teratology of the Ministry of Education and Institute of Experimental Nuclear Medicine, School of Medicine, Shandong Univeristy, Jinan, Shandong 250012, P.R. China
| | - Qingying Yun
- Department of Laboratory, The Second Affiliated Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250012, P.R. China
| | - Hukui Sun
- Key Laboratory for Experimental Teratology of the Ministry of Education and Institute of Experimental Nuclear Medicine, School of Medicine, Shandong Univeristy, Jinan, Shandong 250012, P.R. China
| | - Guangjie Yang
- Department of Nuclear Medicine, Qilu Hospital, School of Medicine, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ting Liang
- Key Laboratory for Experimental Teratology of the Ministry of Education and Institute of Experimental Nuclear Medicine, School of Medicine, Shandong Univeristy, Jinan, Shandong 250012, P.R. China
| | - Chao Zhang
- Key Laboratory for Experimental Teratology of the Ministry of Education and Institute of Experimental Nuclear Medicine, School of Medicine, Shandong Univeristy, Jinan, Shandong 250012, P.R. China
| | - Jing Song
- Key Laboratory for Experimental Teratology of the Ministry of Education and Institute of Experimental Nuclear Medicine, School of Medicine, Shandong Univeristy, Jinan, Shandong 250012, P.R. China
| | - Jiankui Han
- Department of Nuclear Medicine, Qilu Hospital, School of Medicine, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Guihua Hou
- Key Laboratory for Experimental Teratology of the Ministry of Education and Institute of Experimental Nuclear Medicine, School of Medicine, Shandong Univeristy, Jinan, Shandong 250012, P.R. China
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