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A Prospective Evaluation of ¹⁸F-FDG and ¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

¹ Center for Liver Cancer, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea; ² Department of Nuclear Medicine, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea; ³ Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea; and ⁴ Cancer Registration and Biostatistics Branch, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea

Correspondence: For correspondence or reprints contact: Joong-Won Park, Center for Liver Cancer, National Cancer Center, 809 Madu-dong, Ilsan-gu, Goyang, Gyeonggi-do, 411-769, Republic of Korea. E-mail: jwpark{at}ncc.re.kr

Because ¹⁸F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), ¹¹C-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 ¹⁸F-FDG and ¹¹C-acetate PET/CT. Results: The overall sensitivities of ¹⁸F-FDG, ¹¹C-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 -fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive ¹⁸F-FDG PET/CT results. Uptake of ¹¹C-acetate was associated with large and multiple tumors. For ¹⁸F-FDG, the sensitivities according to tumor size (1–2, 2–5, and 5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for ¹¹C-acetate, these respective values were 31.8%, 78.2%, and 95.2%. ¹⁸F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with ¹⁸F-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 ¹⁸F-FDG PET/CT was 64.4% for primary HCC and 84.4% for ¹¹C-acetate PET/CT. The overall sensitivities of ¹⁸F-FDG, ¹¹C-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 ¹¹C-acetate to ¹⁸F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. ¹⁸F-FDG, ¹¹C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but ¹⁸F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.

Key Words: hepatology • oncology • PET/CT • FDG • acetate • hepatocellular carcinoma • sensitivity

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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