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A prospective evaluation of 18F-FDG and 11C-acetate PET/CT for detection of primary and metastatic hepatocellular carcinoma

Cited 194 time in Web of Science Cited 211 time in Scopus

Park, Joong-Won; Kim, Ji Hoon; Kim, Seok Ki; Kang, Keon Wook; Park, Kyung Woo; Choi, Jun-Il; Lee, Woo Jin; Kim, Chang-Min; Nam, Byung Ho

Issue Date
The Society of Nuclear Medicine Inc
J Nucl Med. 2008;49(12):1912-1921
Acetates/*diagnostic useAdultCarbon/*diagnostic useFemaleFluorodeoxyglucose F18/*diagnostic useHumansIncidenceKorea/epidemiologyLiver Neoplasms/*diagnosis/*mortalityMaleMiddle AgedPositron-Emission Tomography/*statistics & numerical dataPrognosisProspective StudiesRadiopharmaceuticals/diagnostic useReproducibility of ResultsRisk Assessment/methodsRisk FactorsSensitivity and SpecificitySubtraction Technique/statistics & numerical dataSurvival AnalysisSurvival RateTomography, X-Ray Computed/*statistics & numerical dataCarcinoma, Hepatocellular/diagnosis/mortality/secondary
Because (18)F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), (11)C-acetate PET has been proposed as another technique for this use. We prospectively evaluated the value of PET/CT using these 2 tracers for the detection of primary and metastatic HCC. METHODS: One hundred twelve patients (99 with HCC, 13 with cholangiocellular carcinoma) underwent biopsy and (18)F-FDG and (11)C-acetate PET/CT. RESULTS: The overall sensitivities of (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT in the detection of 110 lesions in 90 patients with primary HCC were 60.9%, 75.4%, and 82.7%, respectively. Elevated serum alpha-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive (18)F-FDG PET/CT results. Uptake of (11)C-acetate was associated with large and multiple tumors. For (18)F-FDG, the sensitivities according to tumor size (1-2, 2-5, and >/=5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for (11)C-acetate, these respective values were 31.8%, 78.2%, and 95.2%. (18)F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with (18)F-FDG PET/CT positive for all indexed lesions than in those with FDG negative or partially positive through the entire follow-up period. In analysis based on biopsied lesions, the sensitivity of (18)F-FDG PET/CT was 64.4% for primary HCC and 84.4% for (11)C-acetate PET/CT. The overall sensitivities of (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT for 35 metastatic HCCs were 85.7%, 77.0%, and 85.7%, respectively. There was no significant difference in the sensitivity of tracers according to metastatic tumor size, location, or differentiation. CONCLUSION: The addition of (11)C-acetate to (18)F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but (18)F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.
0161-5505 (Print)
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