The use of dual-tracer PET/CT in selection of HCC patients based on Milan criteria before liver transplant

General Clinical Specialties: GastroenterologyObjectives: Selection of HCC patients for liver transplant (LT) is crucial for prognosis and survival. The conventional tool for assessment is contrast CT but its accuracy is suboptimal for detection of early HCC in cirrhotic livers and for metastatic survey. We evaluated the accuracy of dual-tracer (11C-acetate: ACT and 18F-FDG: FDG) PET/CT in selecting candidates for LT based on Milan criteria. Methods: HCC patients status post LT or partial hepatectomy (HCC lesion<7 cm) with both preoperative dual-tracer PET/CT and contrast CT within 1 month were recruited into this study. Dual-tracer PET/CT and contrast CT were reviewed independently based on the parameters specified by Milan criteria: HCC lesion size and number, presence/absence of vascular invasion and extrahepatic metastasis, with postoperative pathology as the gold standard. Statistical analysis was performed using Chi-square test. Results: Forty three HCC patients (M: 34, F: 9, mean: 57±10.1 years) were included. Postoperative pathology confirmed 31 patients satisfying and 12 not satisfying Milan criteria. ACT (29/31: 93.5%) and dual-tracer (30/31: 96.8%) PET/CT were significantly more accurate in patient selection for LT than FDG (8/31: 25.8%) or contrast CT (13/31: 41.9%; all p<0.05). ACT (11/12: 91.7%) and dual-tracer (11/12: 91.7%) PET/CT were also more concordant with pathology in patient exclusion for LT than FDG (6/12: 50.0%) or contrast CT (4/12: 33.3%; all p<0.05). The discordance between contrast CT and pathology was due to: false negative diagnosis (n=17), HCC lesion size (n=6) and number (n=1), and overstaging by false positive diagnosis of vascular (n=2) and extrahepatic metastases (n=2). The discordance between dual-tracer PET/CT and pathology was found in 2 false negative cases with post-treatment necrosis. Conclusions: Dual-tracer PET/CT is significantly more accurate in preoperative assessment and selection of HCC patients for LT. Implementation of this imaging for transplant work-up may be considere

Dual-tracer PET/CT for the differential diagnosis of small liver nodules (1-2 cm) in cirrhosis: Early HCC or dysplastic nodule?

Oncology: Clinical Diagnosis: GI-Colorectal & LiverObjectives: Contrast CT was less accurate in the differentiation of small liver nodules (1-2 cm), particularly in severe cirrhosis. We evaluated the accuracy of dual-tracer (11C-acetate: ACT and 18F-FDG: FDG) PET/CT for the differentiation between small HCC and dysplastic nodules in cirrhotic liver as compared to contrast CT. Methods: Patients with cirrhosis and HCC 1-2 cm confirmed by postoperative pathology after liver transplant or hepatectomy were included if they had both preoperative dual-tracer PET/CT and contrast CT within 1 month. For the diagnosis of HCC, dual-tracer PET/CT was reviewed qualitatively by 3 nuclear medicine physicians in consensus, supported by lesion-to-liver SUV>1.20 (either tracer). Diagnosis by CT was made by 2 radiologists based on the triple-phase pattern of arterial contrast enhancement and washout during portal venous or delayed phase. Each lesion was compared with pathology in terms of diagnosis, size and location. Statistics were analysed by Chi-square and student t tests. Results: 20 patients (M: 15, F: 5, mean: 54±9.2y) with 23 small HCC lesions and 12 dysplastic nodules were identified by postoperative pathology. The mean size of small HCC was 1.6±0.35 cm, dysplastic nodules 1.5±0.34 cm (p>0.05). ACT PET identified 20/23 (87.0%) small HCC lesions while FDG detected 4/23 (17.4%) with dual-tracer sensitivity of 91.3% (21/23). ACT and dual-tracer PET were significantly more sensitive for the diagnosis of early HCC than contrast CT (10/23: 43.5%), with both p<0.05. Of the 23 small HCC lesions, 15 (65.2%) were well and 8 (34.8%) were moderately differentiated. Both FDG and ACT were true negative for all dysplastic nodules (specificity: 100%); while contrast CT misdiagnosed 4 dysplastic nodules as early HCC (specificity: 66.7%). Conclusions: Dual-tracer PET/CT was superior to contrast CT for differentiating small HCC from dysplastic nodules (1-2 cm) in cirrhotic livers. ACT was the PET tracer essential for early HCC detectio

A digital positive youth development game for prevention of bullying and cyberbullying

202309 bcwhAccepted ManuscriptOthersThe Hong Kong Jockey Club Charities TrustPublishe

A digital positive youth development game to prevent intrusion of privacy

202309 bcwhAccepted ManuscriptOthersThe Hong Kong Jockey Club Charities TrustPublishe

Capecitabine but not 5-FU worsened hepatosplenomegaly and liver function when used with oxaliplatin and cetuximab as first-line treatment in K-ras wild-type metastatic colorectal cancer

Theme: Building Bridges to Conquer CancerThis abstract will not be presented at the 2013 ASCO Annual Meeting but has been published in conjunction with the meeting - http://meetinglibrary.asco.org/content/113435-132BACKGROUND: MRC COIN study showed that OXA and CAP (CAPOX) have greater toxicities compared with OXA and 5-FU (FOLFOX) when cetuximab (C225) was added for mCRC. Meanwhile, OXA was associated with splenomegaly and hepatic sinusoidal injury. We investigated if CAPOX+C225 worsened hepatosplenomegaly and liver function compared with FOLFOX+C225 in K-rasWT mCRC. METHODS: 97 patients with K-ras WT mCRC received either FOLFOX or CAPOX ...link_to_OA_fulltex