Research ArticleClinical Investigation

Detection of Hepatocellular Carcinoma with PET/CT: A Prospective Comparison of 18F-Fluorocholine and 18F-FDG in Patients with Cirrhosis or Chronic Liver Disease

Jean-Noël Talbot, Laetitia Fartoux, Sona Balogova, Valérie Nataf, Khaldoun Kerrou, Fabrice Gutman, Virginie Huchet, David Ancel, Jean-Didier Grange and Olivier Rosmorduc
Journal of Nuclear Medicine November 2010, 51 (11) 1699-1706; DOI: https://doi.org/10.2967/jnumed.110.075507

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Maximum-intensity-projection images showing 2 liver foci; the smallest, in inferior part of liver, was 18F-fluorocholine– and 18F-FDG–positive. On transaxial slices of upper part of liver, center of largest lesion was photopenic on both 18F-fluorocholine (left) and 18F-FDG (right) PET/CT images and corresponded to hemorrhagic necrosis. At periphery of this lesion, there was definite 18F-FDG uptake, and 18F-fluorocholine was taken up but with lesser intensity than for noncancerous liver parenchyma (18F-fluorocholine tumor–to–non-tumor ratio T/NTR = 0.97). Postsurgical histology confirmed well-differentiated HCC in this part of lesion. Thus, as compared with nonmalignant liver, HCC tissue was hypermetabolic for 18F-FDG but hypometabolic for 18F-fluorocholine.

  • FIGURE 2.
    FIGURE 2.

    Maximum-intensity-projection images showing 2 liver foci, both hot on 18F-fluorocholine PET (left) but not visible on 18F-FDG PET (right) images. Both liver foci corresponded to untreated well-differentiated HCC.

  • FIGURE 3.
    FIGURE 3.

    Resection of left liver for hepatocholangiocarcinoma; 20-mm nodule subsequently developed in remaining liver (arrow). Nodule appeared hypometabolic for 18F-fluorocholine (bottom left) and avid for 18F-FDG (bottom right); hepatocholangiocarcinoma was confirmed by biopsy. On PET images of thorax (top left, 18F-fluorocholine; top right, 18F-FDG), widespread lung foci were discovered, corresponding to 1 metastasis but also to lesions of anthracosilicosis, and 1 thyroid nodule, which was benign.

  • FIGURE 4.
    FIGURE 4.

    Transaxial liver slice of metastasis of colon cancer: photopenic on 18F-fluorocholine PET/CT (left) and hot on 18F-FDG PET/CT (right) images.

  • FIGURE 5.
    FIGURE 5.

    Maximum intensity projection in case of FNH: 1 liver lesion positive on 18F-fluorocholine PET (left) and not visible on 18F-FDG PET (right) images.

Tables

  • TABLE 1.

    Diagnostic Performance of 18F-Fluorocholine and 18F-FDG PET/CT for Detection of HCC or Other Malignancies in Patients with Liver Nodules on Cirrhosis or Chronic Liver Disease

    18F-fluorocholine PET/CT18F-FDG PET/CT
    ParameterValue95% CIValue95% CIMcNemar test
    Patient-based sensitivity for HCC or hepatocholangiocarcinoma (n = 34)88%73%–97%68%50%–83%NS (P = 0.07)
    Detection rate in patients with other malignancies (n = 8)88%47%–100%88%47%–100%NS
    Patient-based specificity in case of benignity (n = 17)47%23%–72%94%71%–100%P < 0.01
    Overall site-based sensitivity for HCC or hepatocholangiocarcinoma (n = 70)84%74%–92% (hot or photopenic site evocative of malignancy)67%55%–78% (hot site evocative of malignancy)P = 0.01
    Site-based sensitivity for well-differentiated HCC (n = 32)94%79%–99%59%41%–76%P = 0.001
    Site-based sensitivity for poorly differentiated HCC or hepatocholangiocarcinoma (n = 38)76%60%–89%74%57%–87%NS
    Detection rate in other malignant sites (n = 18)78%52%–94%89%65%–99%NS
    Site-based specificity in case of benignity (n = 34)62%44%–78%91%76%–98%P < 0.01

    • NS = nonsignificant.

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