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¹¹C-Acetate PET Imaging in Hepatocellular Carcinoma and Other Liver Masses

¹ Department of Nuclear Medicine and PET, Hong Kong Sanatorium and Hospital, Hong Kong, China
² Department of Radiology, University of Hong Kong, Hong Kong, China
³ Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Hong Kong, China

View larger version (68K): [in a new window]   FIGURE 1. Transaxial sections of liver in 4 patients compare 11C-acetate PET with 18F-FDG PET and CT. (Top) Left patient (A) has well-differentiated HCC in right lobe that shows markedly increased 11C-acetate metabolism but no 18F-FDG accumulation. Middle patient (B) has poorly differentiated HCC in right lobe that shows moderately increased 18F-FDG metabolism and only minimal 11C-acetate activities. Right patient (C) with moderately differentiated HCC in left lobe shows dual tracer uptake. (Bottom) Transaxial sections of liver in another typical patient with HCC show 2 tumor lesions negative on 18F-FDG PET but clearly identified by 11C-acetate PET.

View larger version (61K): [in a new window]   FIGURE 2. Transaxial sections of liver in patient with moderately differentiated HCC of right lobe. CT shows heterogeneous contrast enhancement within tumor. 11C-Acetate PET shows focally accentuated acetate metabolism at anteromedial (AM) part of tumor, whereas 18F-FDG PET shows increased glycolysis at posterolateral (PL) part of tumor. Actual boundary of tumor, mapped from CT image, is drawn to scale on 11C-acetate and 18F-FDG PET images.

View larger version (72K): [in a new window]   FIGURE 3. Three transaxial sections of liver in patient with multifocal HCC disease show complementary characteristics of 11C-acetate and 18F-FDG in PET imaging. 11C-Acetate-avid tumor lesions are marked by "C" and 18F-FDG-avid lesions are marked by "F."

View larger version (82K): [in a new window]   FIGURE 4. (A) Transaxial sections of liver show detection of portal metastasis by 18F-FDG but not by 11C-acetate PET in patient with advanced HCC and poorly differentiated tumor cells. (B) Transaxial sections of brain show metastatic nodule in right frontal lobe from primary, moderately differentiated HCC (confirmed by surgery). This is seen as lesion of increased 11C-acetate metabolism but is almost completely hypometabolic on 18F-FDG PET. Note surrounding edema on 18F-FDG images and background of no activities in normal brain tissue on 11C-acetate images.

View larger version (26K): [in a new window]   FIGURE 5. Composite chart plots lesion-to-liver SUV ratio of all HCC lesions for patients in group Ia (with 3 HCC lesions) against 3 large groups of cellular differentiation. There is no fine line of transition between grades of differentiation; dashed vertical line represents rough transitional zone of visual grading reported by pathologists. Each set of vertical data points is paired: , 11C-acetate; •, 18F-FDG. Values are sorted in descending order of 11C-acetate SUV ratios in each group.

View larger version (68K): [in a new window]   FIGURE 6. Transaxial 11C-acetate PET (A), 18F-FDG PET (B), and CT (C) sections of patient with cholangiocarcinoma (pure adenocarcinoma) show no abnormal 11C-acetate metabolism but show increased 18F-FDG activity within tumor.