FDG PET/CT Early Dynamic Blood Flow and Late Standardized Uptake Value Determination in Hepatocellular Carcinoma

Abstract

Early dynamic blood flow FDG PET/CT may be used to help discriminate and characterize HCC tumors.

Early Dynamic 18F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions

“…Compared with other ED 18 F-FDG PET or CE CT studies (19,21,22), we found a relatively late peak signal in timeactivity curves for both tumor and nontumor tissue. This observation is explained by the fact that we did not adjust our measurements by g-variate fitting-that is, we did not use a mathematic function to exclude recirculation (19,23).…”

“…The present protocol therefore simplified that of Bernstine et al (19) in 2 main ways. First, using ED 18 F-FDG PET/CT to generate CE CT-like images-that is, to depict the arterial, portal venous, and venous phases-and relying largely on simple visual and descriptive endpoints, we reconstructed fewer frames with longer times: 4 frames at 15-s intervals, then 3 frames at 60-s intervals, versus 18 frames at 5-s intervals.…”

“…The suitability of liver ED 18 F-FDG PET/CT for demonstrating HCC hypervascularization recently was elegantly demonstrated by Bernstine et al (19), but the complexity of their protocol limits its routine applicability. Additionally, compared with standard activities, their unusually large 18 F-FDG activity increases patient radiation exposure by approximately 5 mSv, approximately the normal yearly radiation exposure and, at our center, increases cost by approximately $325-390 (U.S. dollars; ;250-300 Euros).…”

“…This observation is explained by the fact that we did not adjust our measurements by g-variate fitting-that is, we did not use a mathematic function to exclude recirculation (19,23). We made this choice because, as previously noted, this pilot study sought to test ED 18 F-FDG PET as a CE CT-like procedure not to estimate blood flow as exactly as possible.…”

“…After Mullani et al (18) demonstrated the efficacy of ED 18 F-FDG PET/CT to measure blood flow in a variety of advanced solid tumors, Bernstine et al (19) successfully applied the modality to assess HCC liver lesion perfusion. However, the Bernstine group used an elaborate protocol requiring laborious, time-consuming calculation that likely precludes the use of the protocol in everyday practice.…”