title: Positron emission tomography for detecting occult hepatocellular carcinoma in hepatitis C cirrhotics awaiting for liver transplantation.
abstract: Patients with hepatitis C cirrhosis may sometimes have persistently elevated alpha feto protein (AFP) despite a lack of evidence for disease by ultrasound or computed tomography (CT). While this pattern may represent a benign manifestation of hepatitis C cirrhosis (HCC), it raises concern for the possibility of an occult hepatocellular carcinoma. It has previously been shown that positron emission tomography (PET scan) may detect occult cholangiocarcinoma in high-risk patients with primary sclerosing cholangitis. We hypothesized that PET scanning might similarly serve for occult HCC in hepatitis C cirrhotics. PET scanning was performed on eight hepatitis C cirrhotics who were on the liver transplantation list and displayed persistently elevated AFP (>100 ng/mL) but no detectable lesions on abdominal CT scan. The results of PET detection of occult HCC were compared to those obtained with lipiodol-enhanced CT scanning and with histologic examination of the live explant. Explant histology or prolonged clinical follow-up showed two subjects to have conclusive evidence of HCC; the remainder, no evidence of malignancy. Although PET imaging did not reveal abnormal lesions in any subject; lipiodol-enhanced CT scans revealed abnormal lipiodol retention in both subjects with HCC. These preliminary findings suggest that PET has no role in detecting occult HCC in high-risk patients. Additionally, these data suggest that some hepatitis C cirrhotics with persistently elevated AFP but no detectable lesions by conventional CT scan may show occult HCC using lipiodol-enhanced CT scans.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, 1001 W. 10th Street, Indianapolis, IN 46202, USA.
authors.forename: S
authors.initials: S
authors.lastname: Liangpunsakul
authors.forename: D
authors.initials: D
authors.lastname: Agarwal
authors.forename: J C
authors.initials: JC
authors.lastname: Horlander
authors.forename: B
authors.initials: B
authors.lastname: Kieff
authors.forename: N
authors.initials: N
authors.lastname: Chalasani
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000821:virology; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors; D014055:Tomography, Emission-Computed / Q000379:methods; D016896:Treatment Outcome; D014850:Waiting Lists