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


CONCLUSIONS
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.
Park
Joong-Won
JW
Center for Liver Cancer, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea. jwpark@ncc.re.kr
Kim
Ji Hoon
JH
Kim
Seok Ki
SK
Kang
Keon Wook
KW
Park
Kyung Woo
KW
Choi
Jun-Il
JI
Lee
Woo Jin
WJ
Kim
Chang-Min
CM
Nam
Byung Ho
BH
D000085:Acetates; D000328:Adult; D002244:Carbon; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000556:secondary; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D015994:Incidence; D007723:Korea / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013382:Subtraction Technique / Q000706:statistics & numerical data; D016019:Survival Analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
D000085:Acetates; D019275:Radiopharmaceuticals; C438206:carbon-11 acetate; D019788:Fluorodeoxyglucose F18; D002244:Carbon