title: Can positron emission tomography with the dual tracers [11 C]acetate and [18 F]fludeoxyglucose predict microvascular invasion in hepatocellular carcinoma?
abstract: Microvascular invasion is a poor prognostic indicator of the recurrence of hepatocellular carcinoma (HCC) after surgical treatment. Positron emission tomography (PET) with [(18) F]fludeoxyglucose ([(18) F]FDG) as a tracer has been employed to predict the prognosis before surgery for various kinds of tumors, but it has not been found to be sensitive enough for HCC. Thus, [(11) C]acetate has been adopted as an additional tracer. This study was designed to evaluate the ability of dual-tracer PET ([(18) F]FDG and [(11) C]acetate) to predict microvascular invasion before liver resection or transplantation. Fifty-eight HCC patients who were preoperatively examined with whole-body dual-tracer PET were studied. Twenty-five patients were [(18) F]FDG-positive, and 56 were [(11) C]acetate-positive. The sensitivity of [(18) F]FDG in detecting primary HCC was 43%, and the sensitivity of [(11) C]acetate was 93%. Twenty-nine patients had HCC with microvascular invasion according to the final pathological examination. The sensitivity, specificity, positive predictive value, and negative predictive value of [(18) F]FDG PET in predicting microvascular invasion were 55.2%, 69%, 64%, and 60.6%, respectively; the corresponding rates for [(11) C]acetate PET were 93.1%, 0%, 48.2%, and 0%. The factors associated with HCC recurrence, which included multifocal involvement, a large tumor size, microsatellite lesions, poor HCC differentiation, and an advanced stage of disease, were analyzed and compared with positive PET results. A tumor size greater than 5 cm was significantly associated with positive [(18) F]FDG PET results; [(11) C]acetate was not associated with poor prognostic indicators. Preoperative [(18) F]FDG PET may predict microvascular invasion. The addition of [(11) C]acetate improves the overall sensitivity of PET, but it has no incremental value in predicting microvascular invasion.
authors.affiliation: Department of Surgery, University of Hong Kong, Hong Kong, China. tantocheung@hotmail.com
authors.forename: Tan To
authors.initials: TT
authors.lastname: Cheung
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Chi Lai
authors.initials: CL
authors.lastname: Ho
authors.forename: Kenneth Siu Ho
authors.initials: KS
authors.lastname: Chok
authors.forename: Albert Chi Yan
authors.initials: AC
authors.lastname: Chan
authors.forename: William Wei
authors.initials: WW
authors.lastname: Sharr
authors.forename: Kelvin Kwok Chai
authors.initials: KK
authors.lastname: Ng
authors.forename: Ronnie Tung Ping
authors.initials: RT
authors.lastname: Poon
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
mesh_terms: D000085:Acetates; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002244:Carbon; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006723:Hong Kong; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000085:Acetates; D019275:Radiopharmaceuticals; C438206:carbon-11 acetate; D019788:Fluorodeoxyglucose F18; D002244:Carbon