Title
PET/CT using 18F-fluoromethylcholine to detect hepatocellular carcinoma and assess extent
of the disease.
Authors:
Matthanja Bieze, MD1
Heinz-Joseph Klumpen, MD2
Joanne Verheij, MD PhD5
Sebastiaan D. Hemelrijk, Medical Student1
Ulrich H.W. Beuers, MD PhD3
Peter S.L. Jansen, MD PhD3
Saffire S.K.S. Phoa, MD PhD4
Youssef El Massoudi, MD1
Thomas M. van Gulik, MD PhD1
Roel J. Bennink, MD PhD6
Affiliations:
1
Department of Surgery, Academic Medical Center, the Netherlands
2
Department of Medical Oncology, Academic Medical Center, the Netherlands
3
Department of Hepatology, Academic Medical Center, the Netherlands
4
Department of Radiology, Academic Medical Center, the Netherlands
5
Department of Pathology, Academic Medical Center, the Netherlands
6
Department of Nuclear Medicine, Academic Medical Center, the Netherlands
Contact information of the first and corresponding author:
Mw. Drs. M. Bieze, MD research fellow
Academic Medical Center
IWO 1-A1-132, Meibergdreef 9
1105 AZ Amsterdam, the Netherlands
Tel:
+31 20 5666653
Fax:
+31 20 6976621
E-mail: M.Bieze@amc.uva.nl
Abstract
Background
Diagnosis of HCC primarily entails imaging, including MR, multiphase-CT and ultrasound.
Positron emission tomography (PET) with the glucose (FDG) tracer has shown additional
value in the detection of metastatic disease in several tumors, but is not sensitive for HCC.
The aim of this study was to assess the usefulness of PET using the 18F-fluoromethylcholine
tracer (18F-FCH) for detection of HCC and evaluation of extent of the disease.
Methods
As of December 2010, 21 patients with HCC >1 cm were included (mean age 62y; range 4779y). Fifteen minutes after iv injection of 18F-FCH a whole-body PET/CT was performed. All
patients underwent a baseline-PET prior to treatment, 3 patients underwent a control-PET
after treatment, and 2 underwent a follow-up-PET after 3-6 months. Standard of reference for
diagnosis was two imaging studies (MR, CT, or ultrasound) if histopathological diagnosis was
not obtained. The standardized uptake value (SUV) of the lesion and surrounding tissue were
assessed, and SUV-ratios calculated. 18F-FCH PET scan was considered positive if the SUVratio exceeded 1.15.
Results
Standard diagnostic work-up revealed 38 hepatic lesions in 21 patients. In 35/38 lesion (92%,
CI 79-97%) the 18F-FCH PET scan was positive (SUV-ratio 2.06 (±0.67)).
Standard diagnostic imaging to assess metastatic disease showed 6 suspicious lesions in lung
or abdomen (all PET positive). Additionally, 1 abdominal lesion, 4 lung and 2 skeletal lesions
were found PET positive and in retrospect also recognized on standard diagnostic imaging.
Finally, 1 lymph node and 2 skeletal lesions were found positive on PET and remained
undetected on standard imaging, but were proven to be HCC during follow-up. Three patients
underwent follow-up PET. Progressive/metastatic disease was detected by 18F-FCH PET in
lung and abdomen of 2 patients, confirmed by histopathology or additional imaging. Overall,
if based on the 18F-FCH PET scan, staging was changed in 7/21 patients (33%), possibly
changing treatment.
Conclusions
These results show promising results in detection of HCC using 18F-FCH PET/CT, with
possible implications for staging and treatment. 18F-FCH PET/CT may therefore be of value
as additional non-invasive imaging tool for evaluation of HCC, including metastatic disease,
treatment response, and follow-up.