Characterization of hepatic tumors using [11C]metomidate through positron emission tomography: comparison with [11C]acetate

Roivainen, Anne; Naum, Alexandru; Nuutinen, Heikki; Leino, Rauli; Nurmi, Heimo; Någren, Kjell; Parkkola, Riitta; Virtanen, Johanna; Kallajoki, Markku; Kujari, Harry; Ovaska, Jari; Roberts, Peter; Seppänen, Marko

doi:10.1186/2191-219x-3-13

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…Recent attempts, with 11 C-metomidate (methyl derivative of etomidate), previously used as an imaging tool in detection of adrenocortical tumors, have been disappointing with low sensitivity for detection of HCC compared with 11 C-acetate [58]. The tracer binds to GABA (gamma-aminobutyric acid) receptors, which are upregulated in HCC [59].…”

Section: • • 18 F-fluorothymidinementioning

confidence: 98%

The emerging role of positron emission tomography in hepatocellular carcinoma

2015

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Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality worldwide. HCC a heterogeneous disease occurring on the background of cirrhosis. The presence of cirrhosis limits the sensitivity of conventional imaging modalities in differentiating HCC from surrounding cirrhotic parenchyma. Positron emission tomography (PET) using F-fluorodeoxyglucose (F-FDG) is widely used for assessing a variety of malignancies, however, has poor sensitivity in the evaluation of HCC. This has led to the investigation of other radiotracers such as C-acetate andC-choline, with improved sensitivity in terms of detection and therapeutic response. In this review, we discuss the emerging field of PET imaging for the detection, staging and assessment of treatment response in HCC. In particular we discuss the role of F-FDG-PET in imaging hepatocellular cancer, the limitations of this PET tracer and emerging novel PET tracers being investigated that exploit key metabolic processes including fatty acid and lipid synthesis, choline kinase activity and gene expression.

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Section: • • 18 F-fluorothymidinementioning

confidence: 98%

The emerging role of positron emission tomography in hepatocellular carcinoma

2015

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“…Considering the benign liver tumours, FNH lesions accumulate FCH [33] and, in more variable proportions, , as in this patient with multiple adenomas, but it is frequently negative with both tracers (color figure online) 11 C-acetate [16,58,59]. From a prognostic perspective, it is important to differentiate HCA, which can degenerate in up to 4 % of lesions [60,61], from FNH composed of normal hepatocytes occurring in a normal liver.…”

Section: Summary Of the Results On The Use Of Lipid Pet Tracers In Nomentioning

confidence: 99%

“…Metastases from non-HCC liver malignancies do not appear as hot foci on PET with lipid tracers [16,29,58], unlike CAC which can be visualised as a hot focus, in a proportion of cases that, however, cannot be evaluated from the small numbers of cases included in available series [16,20,29]. Lesions of tissue density on CT appearing photopenic on FCH PET correspond to malignancy [29].…”

Section: Summary Of the Results On The Use Of Lipid Pet Tracers In Nomentioning

confidence: 99%

Use of choline PET for studying hepatocellular carcinoma

Talbot

Michaud

Grangé

et al. 2014

Clin Transl Imaging

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Accurate detection of hepatocellular carcinoma (HCC) foci in the liver and at the whole-body level has a significant impact on patient management. Functional whole-body imaging by PET (fused with CT or MRI) with spatial resolution compatible with the detection of lesions \2 cm in size has been proposed to overcome some limitations of morphological imaging. 18 F-fluorodeoxyglucose (FDG), the reference PET tracer in oncology, has limitations in the functional imaging of liver tumours. In particular , the detection rate of intra-hepatic, well-differentiated HCC is low and incompatible with effective staging of affected patients. To overcome this lack of sensitivity, choline PET tracers have been used by several teams: 11 C-choline or its analogues. 18 F-fluorocholine (FCH) and 18 F-fluoroethylcholine (FEC). These tracers showed sensitivity compatible with accurate staging of well-differentiated HCC and also of intermediate or poorly differentiated HCC. Dual-tracer PET using FDG and a lipid tracer has the best performance, since the aggressiveness of lesions within a given patient may vary, with some taking up only one tracer. Such variability of uptake may also be seen between different portions of a single large liver nodule. There is some evidence to suggest that a dual-tracer approach can be beneficial in the detection of distant metastases. Dual-tracer PET can also be useful in the selection of patients for liver transplantation or HCC tumour resection, for optimal pre-therapeutic staging, and potentially for prediction of recurrence. In pilot studies, visualisation of HCC tumours with FDG was found to indicate a worse prognosis, whereas visualisation with a lipid tracer was indicative of a better prognosis. Among non-HCC liver malignancies in adults, only cholangiocar-cinoma has been reported to take up lipid tracers in small series; FCH uptake has been reported in a child with recurrent hepatoblastoma. With regard to benign liver tumours, adenoma is rarely visible on choline PET, whereas focal nodular hyperplasia (FNH) is visible as a hot focus in the vast majority of cases. When using PET to characterise a liver nodule as HCC, this uptake by FNH may constitute a source of false-positive results. According to one team, FCH could be a good tracer to use in difficult cases for differentiating between FNH and hepatocellular adenoma which can potentially show malignant degenera-tion. From a logistical point of view, FCH is the easiest of the choline PET tracers: it has a longer half-life (110 min), can be produced industrially, and has been granted a marketing authorisation for this indication. The aim of the article is to provide an overview of PET imaging using the lipid tracer choline and its fluorinated analogues for studying HCC, summarising the currently available results. Color figures online at

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“…Its usefulness is further hampered by significant tracer accumulation in the liver, which, due to its proximity to the right adrenal gland, may obfuscate adrenal pathology. Additionally, occasional tracer uptake in various liver lesions [ 12 ] may provide false-positive imaging results. For [ 11 C]MTO PET to be of use in the lateralization of PA, a few days of dexamethasone pre-treatment is generally necessary, as [ 11 C]MTO binds to both 11ß-hydoxylase and aldosterone synthase [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Radiation dosimetry of para-chloro-2-[18F]fluoroethyl-etomidate: a PET tracer for adrenocortical imaging

Silins,

Moreno,

Wall

et al. 2024

EJNMMI Res

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Background [11C]metomidate, a methyl ester analogue of etomidate, is used for positron emission tomography of adrenocortical cancer, and has been tested in recent clinical trials for lateralization in primary aldosteronism (PA). However, in PA, visualization as well as uptake quantification are hampered by the tracer’s rather high non-specific liver uptake, and its overall clinical usefulness is also limited by the short 20-minute half-life of carbon-11. Therefore, we evaluated para-chloro-2-[18F]fluoroethyl-etomidate, [18F]CETO, a fluorine-18 (T1/2=109.8 min) analogue, as a potential new adrenocortical PET tracer. The aim of this study was to assess radiation dosimetry of [18F]CETO. Results [18F]CETO showed a high uptake in adrenal glands, still increasing at 5 h post injection. Adrenal glands (absorbed dose coefficients 0.100 ± 0.032 mGy/MBq in males and 0.124 ± 0.013 mGy/MBq in females) received the highest absorbed dose. The effective dose coefficient was 20 µSv/MBq. Conclusions [18F]CETO has a favourable biodistribution in humans for adrenal imaging. The effective dose for a typical clinical PET examination with 200 MBq [18F]CETO is 4 mSv. Trial registration ClinicalTrials.gov, NCT05361083 Retrospectively registered 29 April 2022. at, URL: https://clinicaltrials.gov/ct2/show/NCT05361083.

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Characterization of hepatic tumors using [11C]metomidate through positron emission tomography: comparison with [11C]acetate

Cited by 8 publications

References 24 publications

The emerging role of positron emission tomography in hepatocellular carcinoma

The emerging role of positron emission tomography in hepatocellular carcinoma

Use of choline PET for studying hepatocellular carcinoma

Radiation dosimetry of para-chloro-2-[18F]fluoroethyl-etomidate: a PET tracer for adrenocortical imaging

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