PET/CT in patients with hepatocellular carcinoma using [(18)F]fluorocholine: preliminary comparison with [(18)F]FDG PET/CT.
OBJECTIVE
The diagnostic accuracy of [(18)F]fluorodeoxyglucose (FDG) PET is insufficient to characterise hepatocellular carcinoma (HCC) in liver masses and to diagnose all cases of recurrent HCC. HCC has been reported to take up [(11)C]acetate, but routine use of this tracer is difficult. Choline is another tracer of lipid metabolism, present in large amounts in HCC. In a proof-of-concept study, we evaluated [(18)F]fluorocholine (FCH) uptake by HCC and compared FCH PET/CT with FDG PET/CT.


METHODS
Twelve patients with newly diagnosed (n=8) or recurrent HCC (n=4) were prospectively enrolled. HCC was assessed by histology in eight cases and by American Association for the Study of Liver Diseases (AASLD) criteria in four cases. All patients underwent whole-body PET/CT 10 min after injection of 4 MBq/kg FCH. Within 1 week, 9 of the 12 patients also underwent whole-body FDG PET/CT 1 h after injection of 5 MBq/kg FDG.


RESULTS
The per-patient analysis showed a detection rate of 12/12 using FCH PET/CT for both newly diagnosed and recurrent HCC. The median signal to noise ratio was 1.5+/-0.38. There was a trend towards a higher FCH SUV(max) in well-differentiated HCC (15.6+/-7.9 vs 11.9+/-0.9, NS). Of the nine patients who underwent FCH and FDG PET/CT, all nine were positive with FCH whereas only five were positive with FDG.


CONCLUSIONS
FCH provides a high detection rate for HCC, making it potentially useful in the initial evaluation of HCC or in the detection of recurrent disease. The favourable result of this proof-of-concept study opens the way to a phase III prospective study.
Talbot
Jean-Noël
JN
Department of Nuclear Medicine, Hôpital Tenon, AP-HP, et Université Pierre et Marie Curie, Paris, France.
Gutman
Fabrice
F
Fartoux
Laetitia
L
Grange
Jean-Didier
JD
Ganne
Nathalie
N
Kerrou
Khaldoun
K
Grahek
Dany
D
Montravers
Françoise
F
Poupon
Raoul
R
Rosmorduc
Olivier
O
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D002794:Choline / Q000031:analogs & derivatives*; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed / Q000379:methods*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C514960:fluorocholine; D002794:Choline