Value of fusing PET plus CT images in hepatocellular carcinoma and combined hepatocellular and cholangiocarcinoma patients with extrahepatic metastases: preliminary findings

Nagaoka, Sakae; Itano, Satoshi; Ishibashi, Masatoshi; Torimura, Takuji; Baba, Kenkichi; Akiyoshi, Junji; Kurogi, Junichi; Matsugaki, Satoru; Inoue, Kinya; Tajiri, Nobuyoshi; Takada, Ayato; Ando, Eiji; Kuromatsu, Ryoko; Kaida, Hayato; Kurogi, Mina; Koga, Hironori; Kumashiro, Ryukichi; Hayabuchi, Naofumi; Kojiro, Masamichi; Sata, Michio

doi:10.1111/j.1478-3231.2006.01296.x

Cited by 44 publications

(27 citation statements)

References 22 publications

(30 reference statements)

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“…PET/CT is used in HCC patients to detect extrahepatic metastases (11,17), predict outcome after resection (18,19), select liver transplantation candidates (20), and assess residual tumors after treatment with transcatheter arterial chemoembolization or radiofrequency ablation (21). The usefulness of these applications depends on the ability of PET/CT to detect small or atypical lesions-those for which no diagnostic studies with spiral CT or contrastenhanced MRI are available, those in the liver, and those in extrahepatic areas.…”

Section: Discussionmentioning

confidence: 99%

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A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

Park¹,

Kim²,

Kim³

et al. 2008

J Nucl Med

254

237

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Because 18 F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), 11 C-acetate PET has been proposed as another technique for this use. We prospectively evaluated the value of PET/CT using these 2 tracers for the detection of primary and metastatic HCC. Methods: One hundred twelve patients (99 with HCC, 13 with cholangiocellular carcinoma) underwent biopsy and 18 F-FDG and 11 C-acetate PET/CT. Results: The overall sensitivities of 18 F-FDG, 11 C-acetate, and dual-tracer PET/CT in the detection of 110 lesions in 90 patients with primary HCC were 60.9%, 75.4%, and 82.7%, respectively. Elevated serum a-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive 18 F-FDG PET/CT results. Uptake of 11 C-acetate was associated with large and multiple tumors. For 18 F-FDG, the sensitivities according to tumor size (1-2, 2-5, and $5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for 11 C-acetate, these respective values were 31.8%, 78.2%, and 95.2%. 18 F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with 18 F-FDG PET/CT positive for all indexed lesions than in those with FDG negative or partially positive through the entire follow-up period. In analysis based on biopsied lesions, the sensitivity of 18 F-FDG PET/CT was 64.4% for primary HCC and 84.4% for 11 C-acetate PET/CT. The overall sensitivities of 18 F-FDG, 11 C-acetate, and dual-tracer PET/CT for 35 metastatic HCCs were 85.7%, 77.0%, and 85.7%, respectively. There was no significant difference in the sensitivity of tracers according to metastatic tumor size, location, or differentiation. Conclusion: The addition of 11 C-acetate to 18 F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. 18 F-FDG, 11 C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but 18 F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.

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Section: Discussionmentioning

confidence: 99%

“…Twenty milligrams of furosemide were administered intravenously within 10 min of the 18 F-FDG injection, and then 500 mL of water were given. 18 F-FDG (444-740 MBq [12][13][14][15][16][17][18][19][20]) was injected intravenously 4 h after 11 C-acetate PET/CT. Patients were encouraged to rest during the 18 F-FDG uptake period.…”

Section: Imaging Studies and Biopsymentioning

confidence: 99%

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

Park¹,

Kim²,

Kim³

et al. 2008

J Nucl Med

254

237

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“…However, several studies reported that PET or PET/CT is useful for detection of extrahepatic metastases from HCC [18][19][20][21]. Moreover, PET/CT showed higher sensitivity for the detection of bone metastasis than other extrahepatic metastases from HCC [22].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CT and 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

Seo

Choi

Kim

et al. 2011

Nucl Med Mol Imaging

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Purpose Bone metastasis from hepatocellular carcinoma (HCC) can present with soft tissue formation, resulting in oncologic emergency. Contrast-enhanced FDG PET/CT and bone scintigraphy were compared to evaluate characteristics of bone metastases with or without soft tissue formation from HCC. Methods Of 4,151 patients with HCC, 263 patients had bone metastases. Eighty-five patients with bone metastasis from HCC underwent contrast-enhanced FDG PET/CT. Fifty-four of the enrolled subjects had recent 99m Tc-HDP bone scintigraphy available for comparison. Metastatic bone lesions were identified with visual inspection on FDG PET/CT, and maximum standardized uptake value (SUV max ) was used for the quantitative analysis. Confirmation of bone metastasis was based on histopathology, combined imaging modalities, or serial follow-up studies. Results Forty-seven patients (55%) presented with soft tissue formation, while the remaining 38 patients presented without soft tissue formation. Frequent sites of bone metastases from HCC were the spine (39%), pelvis (19%), and rib cage (14%). The soft-tissue-formation group had more frequent bone pain (77 vs. 37%, p<0.0001), higher SUV max (6.02 vs. 3.52, p<0.007), and higher incidence of photon defect in bone scintigraphy (75 vs. 0%) compared to the non-soft-tissue-formation group. FDG PET/CT had higher detection rate for bone metastasis than bone scintigraphy both in lesion-based analysis (98 vs. 53%, p=0.0015) and in patient-based analysis (100 vs. 80%, p<0 .001). Conclusions Bone metastasis from HCC showed a high incidence of soft tissue formation requiring emergency treatment. Although the characteristic findings for soft tissue formation such as photon defect in bone scintigraphy are helpful in detection, overall detectability of bone metastasis is higher in FDG PET/CT. Contrast-enhanced PET/CT will be useful in finding and delineating softtissue-forming bone metastasis from HCC.

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“…The sensitivity and specificity of staging for Colon, lung, and breast malignancies with PET CT is 92-100% and 85-100% respectively. 30 CT Porto angiography is one of the most sensitive imaging for metastasis but it is an examination that is performed in high selected cases, in few institutions and not for all types of liver lesions. Guided FNA will help identifying the primary lesion.…”

Section: Liver Metastasismentioning

confidence: 99%

Nodule in Liver: Investigations, Differential Diagnosis and Follow-up

Rao

2014

Journal of Clinical and Experimental Hepatology

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Conventional ultrasonogram of the abdomen being noninvasive, inexpensive and ubiquitously available is the first imaging modality that raises suspicion of HCC in a patient with chronic liver disease with or without cirrhosis. The lesions in liver particularly nodule are being recognized with increased frequency with the wide spread use of ultrasonogram as the initial investigation and computerized tomography and magnetic resonance imaging subsequently. Any nodule in a cirrhotic liver should be considered as hepatocellular carcinoma until otherwise proved. This approach certainly is helpful in diagnosing HCC at its earliest possible stage to offer meaningful curative measures be it transplant, resection or ablative therapy. After a nodule is detected on ultrasonogram the next imaging modality can be a contrast enhanced study (dynamic CT scan or an MRI) to see if are present or not. Two vital clues for diagnosis of HCC by contrast enhanced imaging are presence of arterial hypervascularity and washout which are considered as "classical imaging features". This sequence of events of arterial uptake followed by washout is highly specific for diagnosis of HCC by imaging. If the features are typical showing classical imaging features (i.e hypervascular in the arterial phase with washout in portal venous or delayed phase) the lesion should be treated as HCC biopsy is not necessary. Nodular lesions showing an atypical imaging pattern, such as iso-or hypovascular in the arterial phase or arterial hypervascularity alone without portal venous washout, should undergo further examinations with another contrast enhanced imaging. Biopsy is advisable for those lesions which do not show classical features on the imaging. ( J CLIN EXP HEPATOL 2014;4:S57-S62) T he diagnosis of HCC is predominantly by imaging modality. Conventional ultrasonogram of the abdomen being noninvasive, inexpensive and ubiquitously available is the first imaging modality that raises suspicion of HCC in a patient with chronic liver disease with or without cirrhosis. This could happen either on surveillance or de novo. At times, particularly in young patients with vertically transmitted HBV infection in Asia pacific and African continents it is not uncommon to come across advanced HCC at the time first presentation. The lesions in liver particularly nodule are being recognized with increased frequency with the wide spread use of ultrasonogram as the initial investigation and computerized tomography and magnetic resonance imaging subsequently. The most important question to be answered is to determine the nature of the nodule i.e. regenerating nodule, HCC, intrahepatic cholangiocarcinoma, metastatic lesion(s) or rarely an infective process. Any nodule in a cirrhotic liver should be considered as hepatocellular carcinoma until otherwise proved. This approach certainly is helpful in diagnosing HCC at its earliest possible stage to offer meaningful curative measures be it transplant, resection or ablative therapy. In this article we intend to answer two issues of ...

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Value of fusing PET plus CT images in hepatocellular carcinoma and combined hepatocellular and cholangiocarcinoma patients with extrahepatic metastases: preliminary findings

Abstract: The fusion of PET plus CT images is useful in detecting extrahepatic metastases in HCC and combined HCC/CC patients.

Cited by 44 publications

References 22 publications

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CT and 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

Nodule in Liver: Investigations, Differential Diagnosis and Follow-up

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Value of fusing PET plus CT images in hepatocellular carcinoma and combined hepatocellular and cholangiocarcinoma patients with extrahepatic metastases: preliminary findings

Abstract: The fusion of PET plus CT images is useful in detecting extrahepatic metastases in HCC and combined HCC/CC patients.

Cited by 44 publications

References 22 publications

A Prospective Evaluation of18F-FDG and11C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

A Prospective Evaluation of18F-FDG and11C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CT and 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

Nodule in Liver: Investigations, Differential Diagnosis and Follow-up

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A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma