title: Diagnostic value of combining ¹¹C-choline and ¹⁸F-FDG PET/CT in hepatocellular carcinoma.
abstract: OBJECTIVE
  In this prospective study, our goal was to emphasize the diagnostic value of combining (11)C-choline and (18)F-FDG PET/CT for hepatocellular carcinoma (HCC) in patients with chronic liver disease.
  
  
  METHODS
  Thirty-three consecutive patients were enrolled. All patients were suspected to have HCC based on CT and/or MRI imaging. A final diagnosis was obtained by histopathological examination or by imaging alone according to American Association for the Study of Liver Disease criteria. All patients underwent PET/CT with both tracers within a median of 5 days. All lesions showing higher tracer uptake than normal liver were considered positive for HCC. We examined how tracer uptake was related to biological (serum α-fetoprotein levels) and pathological (differentiation status, peritumoral capsule and vascular invasion) prognostic markers of HCC, as well as clinical observations at 6 months (recurrence and death).
  
  
  RESULTS
  Twenty-eight HCC, four cholangiocarcinomas and one adenoma were diagnosed. In the HCC patients, the sensitivity of (11)C-choline, (18)F-FDG and combined (11)C-choline and (18)F-FDG PET/CT for the detection of HCC was 75 %, 36 % and 93 %, respectively. Serum α-fetoprotein levels >200 ng/ml were more frequent among patients with (18)F-FDG-positive lesions than those with (18)F-FDG-negative lesions (p < 0.05). Early recurrence (n=2) or early death (n=5) occurred more frequently in patients with (18)F-FDG-positive lesions than in those with (18)F-FDG-negative lesions (p < 0.05).
  
  
  CONCLUSIONS
  The combined use of (11)C-choline and (18)F-FDG PET/CT detected HCC with high sensitivity. This approach appears to be of potential prognostic value and may facilitate the selection of patients for surgical resection or liver transplantation.
authors.affiliation: Department of Nuclear Medicine, Hôpital Antoine Béclère, University Department Hepatinov, Assistance-Publique Hôpitaux de Paris, Clamart, France. angele.castilla@abc.aphp.fr.|IMIV - UMR 1023 Inserm/CEA/Université Paris Sud - ERL 9218 CNRS, Orsay, 91401, France. angele.castilla@abc.aphp.fr.
authors.forename: Maria-Angéla
authors.initials: MA
authors.lastname: Castilla-Lièvre
authors.affiliation: Department of Surgery, Hôpital Antoine Béclère, University Department Hepatinov, Assistance-Publique Hôpitaux de Paris, Université Paris-Sud, Clamart, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Franco
authors.affiliation: IMIV - UMR 1023 Inserm/CEA/Université Paris Sud - ERL 9218 CNRS, Orsay, 91401, France.|CEA, DSV, I2BM, Service Hospitalier Frédéric Joliot, Orsay, 91401, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gervais
authors.affiliation: IMIV - UMR 1023 Inserm/CEA/Université Paris Sud - ERL 9218 CNRS, Orsay, 91401, France.|CEA, DSV, I2BM, Service Hospitalier Frédéric Joliot, Orsay, 91401, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Kuhnast
authors.affiliation: Clinical Research Unit of Hôpitaux universitaires Paris-Sud, Hôpital Kremlin Bicêtre, University Department Hepatinov, Assistance-Publique Hôpitaux de Paris, Kremlin Bicêtre, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Agostini
authors.affiliation: Department of Gastroenterology, Hôpital Antoine Béclère, University Department Hepatinov, Assistance-Publique Hôpitaux de Paris, Université Paris-Sud, Clamart, France.
authors.forename: Lysiane
authors.initials: L
authors.lastname: Marthey
authors.affiliation: IMIV - UMR 1023 Inserm/CEA/Université Paris Sud - ERL 9218 CNRS, Orsay, 91401, France.|CEA, DSV, I2BM, Service Hospitalier Frédéric Joliot, Orsay, 91401, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Désarnaud
authors.affiliation: IMIV - UMR 1023 Inserm/CEA/Université Paris Sud - ERL 9218 CNRS, Orsay, 91401, France.|CEA, DSV, I2BM, Service Hospitalier Frédéric Joliot, Orsay, 91401, France.
authors.forename: Badia-Ourkia
authors.initials: BO
authors.lastname: Helal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002250:Carbon Radioisotopes / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D002794:Choline / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage*
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002794:Choline
keywords: 11C-Choline; 18F-FDG; Cirrhosis; Hepatocellular carcinoma; PET/CT