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

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

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Abstract

Because 18F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), 11C-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 18F-FDG and 11C-acetate PET/CT. Results: The overall sensitivities of 18F-FDG, 11C-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 α-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive 18F-FDG PET/CT results. Uptake of 11C-acetate was associated with large and multiple tumors. For 18F-FDG, the sensitivities according to tumor size (1-2, 2-5, and ≥5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for 11C- acetate, these respective values were 31.8%, 78.2%, and 95.2%. 18F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with 18F-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 18F-FDG PET/CT was 64.4% for primary HCC and 84.4% for 11C-acetate PET/CT. The overall sensitivities of 18F-FDG, 11C-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 11C-acetate to 18F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. 18F-FDG, 11C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but 18F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.

Original languageEnglish
Pages (from-to)1912-1921
Number of pages10
JournalJournal of Nuclear Medicine
Volume49
Issue number12
DOIs
Publication statusPublished - 2008 Dec 1
Externally publishedYes

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Fluorodeoxyglucose F18
Hepatocellular Carcinoma
Neoplasms
carbon-11 acetate
Fetal Proteins
Neoplasm Metastasis
Cholangiocarcinoma
Portal Vein
Thrombosis

Keywords

  • Acetate
  • FDG
  • Hepatocellular carcinoma
  • Hepatology
  • Oncology
  • PET/CT
  • Sensitivity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

A prospective evaluation of 18F-FDG and 11C-acetate PET/CT for detection of primary and metastatic hepatocellular carcinoma. / Park, Joong Won; Kim, Ji Hoon; Seok, Ki Kim; Keon, Wook Kang; Kyung, Woo Park; Choi, Jun Il; Woo, Jin Lee; Kim, Chang Min; Byung, Ho Nam.

In: Journal of Nuclear Medicine, Vol. 49, No. 12, 01.12.2008, p. 1912-1921.

Research output: Contribution to journalArticle

Park, Joong Won ; Kim, Ji Hoon ; Seok, Ki Kim ; Keon, Wook Kang ; Kyung, Woo Park ; Choi, Jun Il ; Woo, Jin Lee ; Kim, Chang Min ; Byung, Ho Nam. / A prospective evaluation of 18F-FDG and 11C-acetate PET/CT for detection of primary and metastatic hepatocellular carcinoma. In: Journal of Nuclear Medicine. 2008 ; Vol. 49, No. 12. pp. 1912-1921.
@article{c2fa5ec4ef554e909611a2f67f67c13e,
title = "A prospective evaluation of 18F-FDG and 11C-acetate PET/CT for detection of primary and metastatic hepatocellular carcinoma",
abstract = "Because 18F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), 11C-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 18F-FDG and 11C-acetate PET/CT. Results: The overall sensitivities of 18F-FDG, 11C-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 α-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive 18F-FDG PET/CT results. Uptake of 11C-acetate was associated with large and multiple tumors. For 18F-FDG, the sensitivities according to tumor size (1-2, 2-5, and ≥5 cm) were 27.2{\%}, 47.8{\%}, and 92.8{\%}, respectively; for 11C- acetate, these respective values were 31.8{\%}, 78.2{\%}, and 95.2{\%}. 18F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with 18F-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 18F-FDG PET/CT was 64.4{\%} for primary HCC and 84.4{\%} for 11C-acetate PET/CT. The overall sensitivities of 18F-FDG, 11C-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 11C-acetate to 18F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. 18F-FDG, 11C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but 18F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.",
keywords = "Acetate, FDG, Hepatocellular carcinoma, Hepatology, Oncology, PET/CT, Sensitivity",
author = "Park, {Joong Won} and Kim, {Ji Hoon} and Seok, {Ki Kim} and Keon, {Wook Kang} and Kyung, {Woo Park} and Choi, {Jun Il} and Woo, {Jin Lee} and Kim, {Chang Min} and Byung, {Ho Nam}",
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TY - JOUR

T1 - A prospective evaluation of 18F-FDG and 11C-acetate PET/CT for detection of primary and metastatic hepatocellular carcinoma

AU - Park, Joong Won

AU - Kim, Ji Hoon

AU - Seok, Ki Kim

AU - Keon, Wook Kang

AU - Kyung, Woo Park

AU - Choi, Jun Il

AU - Woo, Jin Lee

AU - Kim, Chang Min

AU - Byung, Ho Nam

PY - 2008/12/1

Y1 - 2008/12/1

N2 - Because 18F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), 11C-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 18F-FDG and 11C-acetate PET/CT. Results: The overall sensitivities of 18F-FDG, 11C-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 α-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive 18F-FDG PET/CT results. Uptake of 11C-acetate was associated with large and multiple tumors. For 18F-FDG, the sensitivities according to tumor size (1-2, 2-5, and ≥5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for 11C- acetate, these respective values were 31.8%, 78.2%, and 95.2%. 18F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with 18F-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 18F-FDG PET/CT was 64.4% for primary HCC and 84.4% for 11C-acetate PET/CT. The overall sensitivities of 18F-FDG, 11C-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 11C-acetate to 18F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. 18F-FDG, 11C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but 18F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.

AB - Because 18F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), 11C-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 18F-FDG and 11C-acetate PET/CT. Results: The overall sensitivities of 18F-FDG, 11C-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 α-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive 18F-FDG PET/CT results. Uptake of 11C-acetate was associated with large and multiple tumors. For 18F-FDG, the sensitivities according to tumor size (1-2, 2-5, and ≥5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for 11C- acetate, these respective values were 31.8%, 78.2%, and 95.2%. 18F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with 18F-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 18F-FDG PET/CT was 64.4% for primary HCC and 84.4% for 11C-acetate PET/CT. The overall sensitivities of 18F-FDG, 11C-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 11C-acetate to 18F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. 18F-FDG, 11C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but 18F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.

KW - Acetate

KW - FDG

KW - Hepatocellular carcinoma

KW - Hepatology

KW - Oncology

KW - PET/CT

KW - Sensitivity

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