Abstract
Because (18)F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), (11)C-acetate PET has been proposed as another technique for this use. We prospectively evaluated the value of PET/CT using these 2 tracers for the detection of primary and metastatic HCC. One hundred twelve patients (99 with HCC, 13 with cholangiocellular carcinoma) underwent biopsy and (18)F-FDG and (11)C-acetate PET/CT. The overall sensitivities of (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT in the detection of 110 lesions in 90 patients with primary HCC were 60.9%, 75.4%, and 82.7%, respectively. Elevated serum alpha-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive (18)F-FDG PET/CT results. Uptake of (11)C-acetate was associated with large and multiple tumors. For (18)F-FDG, the sensitivities according to tumor size (1-2, 2-5, and >/=5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for (11)C-acetate, these respective values were 31.8%, 78.2%, and 95.2%. (18)F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with (18)F-FDG PET/CT positive for all indexed lesions than in those with FDG negative or partially positive through the entire follow-up period. In analysis based on biopsied lesions, the sensitivity of (18)F-FDG PET/CT was 64.4% for primary HCC and 84.4% for (11)C-acetate PET/CT. The overall sensitivities of (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT for 35 metastatic HCCs were 85.7%, 77.0%, and 85.7%, respectively. There was no significant difference in the sensitivity of tracers according to metastatic tumor size, location, or differentiation. The addition of (11)C-acetate to (18)F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but (18)F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.
Highlights
The prognosis of patients with hepatocellular carcinoma (HCC) is related to tumor stage at presentation and underlying liver function
Previous studies of PET/CT in patients with primary and metastatic HCC enrolled few patients or were retrospective [7,8,9,11,12]. The aim of this prospective study was to validate the value of 18F-FDG and 11C-acetate PET/CT for the detection of primary and metastatic HCC in 112 patients admitted to our center for diagnosis and treatment of primary liver cancer
PET/CT is used in HCC patients to detect extrahepatic metastases [11,17], predict outcome after resection [18,19], select liver transplantation candidates [20], and assess residual tumors after treatment with transcatheter arterial chemoembolization or radiofrequency ablation [21]
Summary
The prognosis of patients with hepatocellular carcinoma (HCC) is related to tumor stage at presentation and underlying liver function. 11C-labeled acetate PET effectively detects urologic malignancies [10] This tracer enters the Krebs cycle as a substrate for b-oxidation in fatty acid synthesis and cholesterol synthesis. Has improved sensitivity for detection of well-differentiated HCCs and that none of the primary HCC lesions was negative for 18F-FDG and 11C-acetate tracers [6]. Previous studies of PET/CT in patients with primary and metastatic HCC enrolled few patients or were retrospective [7,8,9,11,12] The aim of this prospective study was to validate the value of 18F-FDG and 11C-acetate PET/CT for the detection of primary and metastatic HCC in 112 patients admitted to our center for diagnosis and treatment of primary liver cancer
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