Abstract
Purpose
The diagnostic accuracy of [18F]fluorodeoxyglucose (FDG) PET is insufficient to characterise hepatocellular carcinoma (HCC) in liver masses and to diagnose all cases of recurrent HCC. HCC has been reported to take up [11C]acetate, but routine use of this tracer is difficult. Choline is another tracer of lipid metabolism, present in large amounts in HCC. In a proof-of-concept study, we evaluated [18F]fluorocholine (FCH) uptake by HCC and compared FCH PET/CT with FDG PET/CT.
Methods
Twelve patients with newly diagnosed (n=8) or recurrent HCC (n=4) were prospectively enrolled. HCC was assessed by histology in eight cases and by American Association for the Study of Liver Diseases (AASLD) criteria in four cases. All patients underwent whole-body PET/CT 10 min after injection of 4 MBq/kg FCH. Within 1 week, 9 of the 12 patients also underwent whole-body FDG PET/CT 1 h after injection of 5 MBq/kg FDG.
Results
The per-patient analysis showed a detection rate of 12/12 using FCH PET/CT for both newly diagnosed and recurrent HCC. The median signal to noise ratio was 1.5±0.38. There was a trend towards a higher FCH SUVmax in well-differentiated HCC (15.6±7.9 vs 11.9±0.9, NS). Of the nine patients who underwent FCH and FDG PET/CT, all nine were positive with FCH whereas only five were positive with FDG.
Conclusion
FCH provides a high detection rate for HCC, making it potentially useful in the initial evaluation of HCC or in the detection of recurrent disease. The favourable result of this proof-of-concept study opens the way to a phase III prospective study.
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References
Zornig C, Broelsch CE. Impact of staging on the treatment of hepatocellular carcinoma. Endoscopy 1993;25:138–142
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693–699
Delbeke D, Martin WH, Sandler MP, Chapman WC, Wright JK Jr, Pinson CW. Evaluation of benign vs malignant hepatic lesions with positron emission tomography. Arch Surg 1998;133:510–515, discussion 515–516
Khan MA, Combs CS, Brunt EM, Lowe VJ, Wolverson MK, Solomon H, et al. Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol 2000;32:792–797
Okazumi S, Isono K, Enomoto K, Kikuchi T, Ozaki M, Yamamoto H, et al. Evaluation of liver tumors using fluorine-18-fluorodeoxyglucose PET: characterization of tumor and assessment of effect of treatment. J Nucl Med 1992;33:333–339
Trojan J, Schroeder O, Raedle J, Baum RP, Herrmann G, Jacobi V, et al. Fluorine-18 FDG positron emission tomography for imaging of hepatocellular carcinoma. Am J Gastroenterol 1999;94:3314–3319
Ho CL, Yu SC, Yeung DW. 11C-acetate PET imaging in hepatocellular carcinoma and other liver masses. J Nucl Med 2003;44:213–221
Li CW, Kuo YC, Chen CY, Kuo YT, Chiu YY, She FO, et al. Quantification of choline compounds in human hepatic tumors by proton MR spectroscopy at 3 T. Magn Reson Med 2005;53:770–776
Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology 2005;42:1208–1236
Rush C, Stern J. Gallium-67 SPECT imaging in hepatocellular carcinoma. Clin Nucl Med 1988;13:535–537
Serafini AN, Jeffers LJ, Reddy KR, Heiba S, Schiff ER. Early recognition of recurrent hepatocellular carcinoma utilizing gallium-67 citrate scintigraphy. J Nucl Med 1988;29:712–716
Chang CS, Yang SS, Yeh HZ, Kao CH, Chen GH. Tc-99m MIBI liver imaging for hepatocellular carcinoma: correlation with P-glycoprotein-multidrug-resistance gene expression. Hepatogastroenterology 2004;51:211–214
Shreve P, Chiao PC, Humes HD, Schwaiger M, Gross MD. Carbon-11-acetate PET imaging in renal disease. J Nucl Med 1995;36:1595–1601
Shreve PD, Gross MD. Imaging of the pancreas and related diseases with PET carbon-11-acetate. J Nucl Med 1997;38:1305–10.
Yoshimoto M, Waki A, Yonekura Y, Sadato N, Murata T, Omata N, et al. Characterization of acetate metabolism in tumor cells in relation to cell proliferation: acetate metabolism in tumor cells. Nucl Med Biol 2001;28:117–122
DeGrado TR, Coleman RE, Wang S, Baldwin SW, Orr MD, Robertson CN, et al. Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer. Cancer Res 2001;61:110–117
Hara T. 18F-fluorocholine: a new oncologic PET tracer. J Nucl Med 2001;42:1815–1817
Kwee SA, Coel MN, Lim J, Ko JP. Prostate cancer localization with 18fluorine fluorocholine positron emission tomography. J Urol 2005;173:252–255
Schmid DT, John H, Zweifel R, Cservenyak T, Westera G, Goerres GW, et al. Fluorocholine PET/CT in patients with prostate cancer: initial experience. Radiology 2005;235:623–628
Ruiz-Cabello J, Cohen JS. Phospholipid metabolites as indicators of cancer cell function. NMR Biomed 1992;5:226–233
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Talbot, JN., Gutman, F., Fartoux, L. et al. PET/CT in patients with hepatocellular carcinoma using [18F]fluorocholine: preliminary comparison with [18F]FDG PET/CT. Eur J Nucl Med Mol Imaging 33, 1285–1289 (2006). https://doi.org/10.1007/s00259-006-0164-9
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DOI: https://doi.org/10.1007/s00259-006-0164-9