Role of PET CT in comparison to triphasic CT in early follow-up of hepatocellular carcinoma after transarterial chemoemoblization

Background The transcatheter arterial chemoembolization (TACE) is one of the treatment lines for patients with hepatocellular carcinoma (HCC), this study was conducted to assess the role of functional imaging including the DWI, ADC and 18F-2-fluoro-2-deoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) for detection of residual HCC after TACE as compared to the structural liver imaging reporting and data system (LI-RADS). Results The optimal cut off value of standardized uptake value ratio (SUVmax/liver SUVmean ratio) for detection of residual viable HCC after TACE was 1.09 with 88.9%, 87.5% and 88.6% sensitivity, specificity, and accuracy respectively, a lower diagnostic value was noted in the qualitative visual FDG PET/CT assessment with sensitivity, specificity, and accuracy of 81.5%, 75% and 80% respectively. The sensitivity, specificity, and accuracy of DWI for identification of post-TACE viable HCC were 77.8%, 75%, and 77.1% respectively. The optimal cut off value of ADC for the diagnosis of variable HCC was 1.32 × 10−3 mm2/s with sensitivity, specificity, and accuracy of 81.5%, 75%, and 80% respectively. Conclusions DWI, ADC and FDG PET/CT are effective functional imaging modalities for the evaluation of viable residual HCC post-TACE with comparable findings for the dynamic cross-section imaging.

Section: F Esupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

The role of functional imaging; DWI, ADC and 18F-FDG PET/CT in the evaluation of HCC treatment response after transarterial chemoembolization

Abdelrahman

Abdel-Rahman

Taha

2021

The role of triphasic CT imaging and 18F FDG PET CT on detection of extrahepatic metastases and proper staging of HCC: a comparative study

Barakat

Badran²,

Allam³

et al. 2022

Background Extrahepatic metastases and proper staging of HCC are mandatory for proper assessment of the disease process and its exact extent. Subsequently, clinicians can put precise management and treatment strategies for patients with metastatic HCC. 18FFDG PET/CT is one of the best imaging modalities for the proper detection of metastases and staging. It can provide both functional information and high contrast resolution of CT. Results On comparison between 18F FDG PET/CT and triphasic CT regarding metastases PET/CT showed greater sensitivity (92.3%) and specificity (84.4%), than triphasic CT (51.3%), (81/3%), and (76.9%), respectively. PET/CT revealed that the SUV max cutoff point for diagnosis of HCC was > 3.PET/CT revealed an SUV max cutoff point of > 5.57 for predicting that HCC has extrahepatic metastases. PET/CT revealed an SUV max cutoff point of > 3.35 for differentiating between metastatic and nonmetastatic lesions. Conclusions PET/CT combines the advantages of the excellent functional information provided by PET and the contrast resolution of CT. It increases the rate of detection of extrahepatic metastases, so it is more sensitive than triphasic CT in the staging of HCC. Using the standard uptake value proved to be efficient in HCC diagnosis and staging being more related to the functional activity of the tumor cells.

Role of 18F-FDG PET/CT in assessment of HCC patients after therapeutic interventions compared to DW MRI

Nashi

Morsy

Shalaby

et al. 2022

Background Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide in both men and women. Early-stage HCCs are treated either by curative surgical resection and/or by locoregional interventions, such as radiofrequency ablation or trans-arterial chemoembolization. Functional imaging as diffusion-weighted magnetic resonance imaging (DW MRI) and metabolic imaging with 18F-positron emission tomography/computed tomography (18F-FDG PET/CT) has been used for assessment of treatment response. This retrospective study was conducted on 29 patients known to have HCC with locoregional therapeutic interventions and referred for radiological follow-up searching for residual/recurrence neoplasia or metastatic deposits. The study aimed to assess the benefits of using the metabolic parameters of 18F-FDG PET/CT in the follow-up of HCC patients after therapeutic interventions in comparison with DW MRI. Results Regarding qualitative assessment of residual active viable HCC by PET/CT and DW MRI, the sensitivity, specificity, PPV, NPP and accuracy were 77.3%, 91.7%, 94.4%, 68.8%, 82.4% and 95.5%, 75%, 87.5%, 90%, 88.2%, respectively. The optimal cutoff point of the SUVmax to differentiate viable from non-viable HCC was 3.4 (AUC = 0.898), with sensitivity, specificity, PPV and NPV of 77.27%, 100.0%, 100.0% and 66.7%, respectively. The optimal ADC cutoff value for discrimination between viable and non-viable HCC was 1247 mm2/s (AUC = 0.976) with sensitivity, specificity, PPV and NPV of 90.48%, 100.0%, 100.0% and 83.3%, respectively. New hepatic lesions were found in 38.2% of patients by DW MRI, while detected only in 26.5% of patients by PET/CT. The PET/CT revealed extrahepatic metastasis in 44.1% of patients, while detected only in 8.8% of patients by DW MRI. Conclusions DWI was more sensitive than PET/CT for detecting tumor residual and hepatic recurrence compared to PET/CT which was much better in detecting distant metastases.