Positron emission tomography with lipid metabolism markers for primary liver cancers imaging

Czech version

Authors: Ľudovít Lukáč ¹; Branislav Kunčák ²; Marika Vereb ³; Lucia Kaliská ⁴; Soňa Balogová ^5,6
Authors‘ workplace: I. Interná klinika LF UK a UNB, Bratislava ¹; Interné oddelenie, Nemocnica Nové Zámky ²; Nuklearmedizin, Kassel, Nemecko ³; INMM, Banská Bystrica ⁴; Klinika nukleárnej medicíny LF UK a OÚSA, Bratislava ⁵; Klinika nukleárnej medicíny nemocnice Tenon AP-HP a Univerzity Pierre et Marie Curie, Paríž, Francúzsko ⁶
Published in: NuklMed 2014;3:22-30
Category: Review Article

Overview

Accurate staging of HCC has a significant impact on patient management. ¹⁸F-fluorodeoxyglucose (FDG) has limitations in the functional imaging of liver tumours, in particular the detection rate of intra-hepatic well-differentiated hepatocellular carcinoma (HCC) is low. To overcome this lack of sensitivity, choline PET tracers have proposed: ¹¹C-choline or its analogues ¹⁸F-fluorocholine (FCH) and ¹⁸F-fluoroethylcholine (FEC). They showed sensitivity compatible with an accurate staging of well-differentiated HCC and also of intermediate or poorly differentiated HCC. Actually dual tracer PET with FDG and a lipid tracer has the best performance, as some lesions in a given patients may be of a different aggressiveness and take-up only one tracer. In this aim, visualisation of HCC tumours with FDG is pejorative, whereas visualisation with a lipid tracer was indicative of a better prognosis in pilot studies. Some evidence has also been brought that the detection of distant metastasis benefit from a dual tracer approach.

Among non-HCC liver malignancies in adults, only cholangiocarcinoma has been reported to take up lipid tracers in small series; FCH uptake has been reported in a child with recurrent hepatoblastoma. Concerning benign liver tumours, adenoma is rarely visible on choline PET, whereas focal nodular hyperplasia (FNH) is visible as a hot focus in the majority of cases. To characterize a liver nodule as HCC, this uptake by FNH may be seen as a source of false-positive results. FCH could be helpful to differentiate in difficult cases between FNH and hepatocellular adenoma which has the potential to degenerate.

Key Words:
choline, PET, FCH, liver tumour, hepatocellular carcinoma, focal nodular hyperplasia, hepatoblastoma

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Nuclear Medicine

2014 Issue 2