Maria-Angéla Castilla-Lièvre1,2, Dominique Franco3, Philippe Gervais4,5, Bertrand Kuhnast4,5, Hélène Agostini6, Lysiane Marthey7, Serge Désarnaud4,5, Badia-Ourkia Helal4,5. 1. Department of Nuclear Medicine, Hôpital Antoine Béclère, University Department Hepatinov, Assistance-Publique Hôpitaux de Paris, Clamart, France. angele.castilla@abc.aphp.fr. 2. IMIV - UMR 1023 Inserm/CEA/Université Paris Sud - ERL 9218 CNRS, Orsay, 91401, France. angele.castilla@abc.aphp.fr. 3. Department of Surgery, Hôpital Antoine Béclère, University Department Hepatinov, Assistance-Publique Hôpitaux de Paris, Université Paris-Sud, Clamart, France. 4. IMIV - UMR 1023 Inserm/CEA/Université Paris Sud - ERL 9218 CNRS, Orsay, 91401, France. 5. CEA, DSV, I2BM, Service Hospitalier Frédéric Joliot, Orsay, 91401, France. 6. Clinical Research Unit of Hôpitaux universitaires Paris-Sud, Hôpital Kremlin Bicêtre, University Department Hepatinov, Assistance-Publique Hôpitaux de Paris, Kremlin Bicêtre, France. 7. Department of Gastroenterology, Hôpital Antoine Béclère, University Department Hepatinov, Assistance-Publique Hôpitaux de Paris, Université Paris-Sud, Clamart, France.
Abstract
PURPOSE: In this prospective study, our goal was to emphasize the diagnostic value of combining (11)C-choline and (18)F-FDG PET/CT for hepatocellular carcinoma (HCC) in patients with chronic liver disease. METHODS: Thirty-three consecutive patients were enrolled. All patients were suspected to have HCC based on CT and/or MRI imaging. A final diagnosis was obtained by histopathological examination or by imaging alone according to American Association for the Study of Liver Disease criteria. All patients underwent PET/CT with both tracers within a median of 5 days. All lesions showing higher tracer uptake than normal liver were considered positive for HCC. We examined how tracer uptake was related to biological (serum α-fetoprotein levels) and pathological (differentiation status, peritumoral capsule and vascular invasion) prognostic markers of HCC, as well as clinical observations at 6 months (recurrence and death). RESULTS: Twenty-eight HCC, four cholangiocarcinomas and one adenoma were diagnosed. In the HCC patients, the sensitivity of (11)C-choline, (18)F-FDG and combined (11)C-choline and (18)F-FDG PET/CT for the detection of HCC was 75 %, 36 % and 93 %, respectively. Serum α-fetoprotein levels >200 ng/ml were more frequent among patients with (18)F-FDG-positive lesions than those with (18)F-FDG-negative lesions (p < 0.05). Early recurrence (n=2) or early death (n=5) occurred more frequently in patients with (18)F-FDG-positive lesions than in those with (18)F-FDG-negative lesions (p < 0.05). CONCLUSION: The combined use of (11)C-choline and (18)F-FDG PET/CT detected HCC with high sensitivity. This approach appears to be of potential prognostic value and may facilitate the selection of patients for surgical resection or liver transplantation.
PURPOSE: In this prospective study, our goal was to emphasize the diagnostic value of combining (11)C-choline and (18)F-FDG PET/CT for hepatocellular carcinoma (HCC) in patients with chronic liver disease. METHODS: Thirty-three consecutive patients were enrolled. All patients were suspected to have HCC based on CT and/or MRI imaging. A final diagnosis was obtained by histopathological examination or by imaging alone according to American Association for the Study of Liver Disease criteria. All patients underwent PET/CT with both tracers within a median of 5 days. All lesions showing higher tracer uptake than normal liver were considered positive for HCC. We examined how tracer uptake was related to biological (serum α-fetoprotein levels) and pathological (differentiation status, peritumoral capsule and vascular invasion) prognostic markers of HCC, as well as clinical observations at 6 months (recurrence and death). RESULTS: Twenty-eight HCC, four cholangiocarcinomas and one adenoma were diagnosed. In the HCCpatients, the sensitivity of (11)C-choline, (18)F-FDG and combined (11)C-choline and (18)F-FDG PET/CT for the detection of HCC was 75 %, 36 % and 93 %, respectively. Serum α-fetoprotein levels >200 ng/ml were more frequent among patients with (18)F-FDG-positive lesions than those with (18)F-FDG-negative lesions (p < 0.05). Early recurrence (n=2) or early death (n=5) occurred more frequently in patients with (18)F-FDG-positive lesions than in those with (18)F-FDG-negative lesions (p < 0.05). CONCLUSION: The combined use of (11)C-choline and (18)F-FDG PET/CT detected HCC with high sensitivity. This approach appears to be of potential prognostic value and may facilitate the selection of patients for surgical resection or liver transplantation.
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