PT  - JOURNAL ARTICLE
AU  - Markus Hartenbach
AU  - Stefan Weber
AU  - Nathalie L. Albert
AU  - Sabrina Hartenbach
AU  - Albert Hirtl
AU  - Mathias J. Zacherl
AU  - Philipp M. Paprottka
AU  - Reinhold Tiling
AU  - Peter Bartenstein
AU  - Marcus Hacker
AU  - Alexander R. Haug
TI  - Evaluating Treatment Response of Radioembolization in Intermediate-Stage Hepatocellular Carcinoma Patients Using <sup>18</sup>F-Fluoroethylcholine PET/CT
AID  - 10.2967/jnumed.115.158758
DP  - 2015 Nov 01
TA  - Journal of Nuclear Medicine
PG  - 1661--1666
VI  - 56
IP  - 11
4099  - http://jnm.snmjournals.org/content/56/11/1661.short
4100  - http://jnm.snmjournals.org/content/56/11/1661.full
SO  - J Nucl Med2015 Nov 01; 56
AB  - The aim of this study was to evaluate 18F-fluoroethylcholine PET/CT as a metabolic imaging technique for the assessment of treatment response to 90Y radioembolization in patients with locally advanced hepatocellular carcinoma (HCC). Methods: Thirty-four HCC patients undergoing 78 18F-fluoroethylcholine PET/CT scans were identified for this study. Patients with initial or follow-up metastastic disease (n = 9) were excluded at the time point of the metastatic occurrence as well as patients with negative α-fetoprotein (AFP; n = 1), resulting in 24 patients and 57 scans that were eligible. All patients were scheduled for radioembolization and underwent 1 pretherapeutic and at least 1 posttherapeutic 18F-fluoroethylcholine PET/CT scan. Volume-of-interest analysis and volume-of-interest subtractions were performed. Maximum, mean, and peak standardized uptake value (SUV) analysis was performed, and the total intrahepatic 18F-fluoroethylcholine positive tumor volume (FEC-PTV) and tumor-to-background ratio were assessed. Statistical analysis was performed using a decreasing AFP of at least 20% as a standard of reference for therapy response including receiver-operating-characteristic analyses as well as descriptive and correlation analyses and multiple logistic regression. Results: Fourteen follow-up examinations were categorized as responder and 19 follow-up examinations as nonresponder. Absolute AFP values did not correlate with SUV parameters (P = 0.055). In receiver-operating-characteristic analyses, the initial mean SUV, Δmaximum SUV, and Δtumor-to-background ratio demonstrated the highest area under the curve, 0.84 (P = 0.009), 0.83 (P = 0.011), and 0.83 (P = 0.012), respectively, resulting in a positive prediction of 82%, 83%, and 91% at the respective cutoff points. When multiple logistic regression analysis was applied, this resulted in an area under the curve of 0.90 (P = 0.001), with a positive prediction of 94% and a sensitivity of 94%. The FEC-PTV did not reach significance in the presented dataset. Conclusion: 18F-fluoroethylcholine PET/CT demonstrates a high potential for follow-up assessment in the context of radioembolization in patients with locally advanced, but nonmetastatic, HCC and initially elevated AFP, possibly enabling early therapy monitoring independent of morphology.