Detection of Hepatocellular Carcinoma with PET/CT: A Prospective Comparison of¹⁸F-Fluorocholine and¹⁸F-FDG in Patients with Cirrhosis or Chronic Liver Disease

Abstract

This prospective study aimed to compare the diagnostic performance of 18 F-fluorocholine and 18 F-FDG for detecting and staging hepatocellular carcinoma (HCC) in patients with chronic liver disease and suspected liver nodules. Methods: Whole-body PET/CT was performed in a random order at 10 min after injection of 4 MBq of 18 F-fluorocholine per kilogram and at 1 h after injection of 5 MBq of 18 F-FDG per kilogram. PET/CT results were read in a masked manner by 2 specialists, and diagnostic performance was assessed from the results of consensus masked reading. Those focal lesions appearing with increased or decreased activity, compared with background, on 18 F-fluorocholine PET/CT were considered positive for malignancy. The standard of truth was determined on a per-site basis using data from a histologic examination and a follow-up period of more than 6 mo; on a per-patient basis, the Barcelona criteria were also accepted as a proof of HCC in 5 patients. Results: Eighty-one patients were recruited; standard of truth was determined in 59 cases. HCC was diagnosed in 34 patients. Therefore, sensitivity was 88% for 18 F-fluorocholine and 68% for 18 F-FDG (P 5 0.07), and in 70 sites, sensitivity was 84% for 18 F-fluorocholine, significantly better than the 67% for 18 F-FDG (P 5 0.01). Of the 11 patients with well-differentiated HCC, 6 had a positive result with 18 F-fluorocholine alone, whereas 18 F-FDG was never positive alone; corresponding site-based sensitivity was 94% for 18 F-fluorocholine and 59% for 18 F-FDG (P 5 0.001). The detection rate of 18 sites corresponding to other malignancies was 78% for 18 F-fluorocholine and 89% for 18 F-FDG. In nonmalignant sites, 18 F-fluorocholine appeared less specific than 18 F-FDG (62% vs. 91% P , 0.01) because of uptake by focal nodular hyperplasia. Conclusion: 18 F-fluorocholine was significantly more sensitive than 18 F-FDG at detecting HCC, in particular in well-differentiated forms. In contrast, 18 F-FDG appeared somewhat more sensitive at detecting other malignancies and was negative in focal nodular hyperplasia. Thus 18 F-fluorocholine appears to be a useful PET/CT tracer for the detection and surveillance of HCC; however, performing PET/CT with both radiopharmaceuticals seems to be the best option.

Current Molecular Imaging Positron Emitting Radiotracers in Oncology

“…In other organs, such as the liver, the tumor can be detected despite moderate normal liver tissue uptake. A compared study of FCH-PET and FDG-PET showed that FCH was significantly more sensitive than FDG at detecting hepatocellular carcinoma, particularly in well-differentiated forms; furthermore, FCH was also effective in differentiating hepatocellular adenoma from focal nodular hyperplasia [45]. In summary, FCH is a promising PET tracer for tumor imaging when FDG-PET has a high background uptake.…”

FDG and other radiopharmaceuticals in the evaluation of liver lesions

“…Talbot et al [45] recently proposed more evidence on the topic of FDG and F-Ch in the evaluation of primary liver cancer. Their 2010 prospective study evaluated the use of F-Ch and compared it with FDG in detecting HCC and other malignancies in patients with known cirrhosis or chronic liver disease.…”

New Imaging Techniques for 90Y Microsphere Radioembolization

“…The place of other molecular imaging biomarkers is currently being evaluated, such as the18F-fluorocholine or 11C-acetate [24]. Also, some of these tumors have a high expression of somatostatine receptors and might therefore be imaged using radiolabelled octreotide and PET-CT or SPECT-CT (see lower).…”

“…This neoplasm, deriving from the biliary ducts, is subdivised in 3 types: intra-hepatic, peri-hilar and extra-hepatic type. Distant metastasis can involve lymph nodes (50% at presentation), peritoneal cavity or distant organs (10-20% at presentation) [24]. Prognosis of patients with non resectable cholangiocarcinoma is generally unfavourable.…”