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Diagnostic Accuracy of (18) F-Methylcholine Positron Emission Tomography/Computed Tomography for Intra- and Extrahepatic Hepatocellular Carcinoma

By Matthanja Bieze, Heinz-Josef Klümpen, Joanne Verheij, Ulrich Beuers, Saffire S. K. S. Phoa, Thomas M. van Gulik and Roelof J. Bennink


Diagnosis of hepatocellular carcinoma (HCC) primarily involves imaging. The aim of this study was to assess the accuracy of F-18-fluorocholine (F-18-FCH) positron emission tomography (PET) for detection of HCC and evaluation of extent of disease. Patients with HCC >1 cm were included between 2009 and July 2011, and follow-up closed in February 2013. Diagnosis was based on American Association for the Study of Liver Diseases criteria, and all patients underwent F-18-FCH PET/computed tomography (CT) at baseline before treatment, 6 underwent a second PET/CT posttreatment, and 1 a third during follow-up. Whole-body PET and low-dose CT imaging were performed 15 minutes after F-18-FCH injection. Evaluation of imaging was done with standardized uptake value (SUV) ratios: SUV maximum of the lesion divided by the SUV mean of surrounding tissue. Statistical analyses included descriptive analyses, receiver operating characteristic curve, McNemar's test, and Kaplan-Meier's test at 5% level of significance. Twenty-nine patients revealed 53 intrahepatic lesions. In 48 of 53 lesions, F-18-FCH PET was positive (SUVratio, 1.95 +/- 0.66; sensitivity, 88%; specificity, 100%). PET/CT showed uptake in 18 extrahepatic lesions and no uptake in 3 lesions affirmed non-HCC lesions; all lesions were confirmed with additional investigation (accuracy, 100%). In 17 of 29 patients, additional lesions were found on PET/CT imaging, with implications for treatment in 15 patients. Posttreatment PET/CT showed identical results, compared with standard treatment evaluation. Conclusion: This study shows additional value of F-18-FCH PET/CT for patients with HCC. F-18-FCH PET/CT has implications for staging, management, and treatment evaluation because of accurate assessment of extrahepatic disease. (Hepatology 2014;59:996-1006

Year: 2014
DOI identifier: 10.1002/hep.26781
OAI identifier:
Provided by: NARCIS
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