The role of positron emission tomography in the diagnosis and treatment of oncological diseases of the hepatobiliary system

Abstract

The article highlights the role of PET and SIRT in the diagnosis and treatment of cholangiocarcinoma and HCR. In HCR, PET can be useful in detecting distant metastases, assessing overall and recurrence-free survival. In the case of cholangiocarcinoma, PET is more diagnostically informative than CT when detecting distant metastases and plays an important role in predicting recurrence after surgical resection. Data on the use of various types of radiopharmaceuticals and their combinations are provided. A comparison of their sensitivity and specificity is presented, which showed the best results when using the combination of FDG + choline. The effectiveness of PET in the selection of patients before transplantation, the ability to assess the distribution of activity and to quantify the absorbed dose in SIRT, which in turn allows to predict the therapeutic response and outcome, has been demonstrated. Different types of microspheres for SIRT are considered, in particular, 90Y-resin, 90Y-glass, and 166Ho-poly-L-lactic acid (PLLA). Among them, the most interesting are 166Ho microspheres, which have the advantage of being able to perform diagnostics and treatment with the same radiological label, i.e., to be used in a theranostic approach, theoretically reducing discrepancies between the planning and treatment procedure. SIRT can be used both alone and in combination with other types of treatment at different stages of tumor disease.