Positron emission tomography scanning in the evaluation of hepatocellular carcinoma

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Abstract

Background/Aims:18F-fluorodeoxyglucose uptake allows estimation of glucose metabolism by tumor cells using positron emission tomography (PET). We evaluated the role of PET imaging in the diagnosis of hepatocellular carcinoma.

Methods: PET images were collected after intravenous injection of 8–12 mCi of 18F-FDG in 20 patients with hepatocellular carcinoma (HCC). PET tumor activity level was assessed on a scale of 1 to 4 compared to normal liver tissue. The PET score was compared with abdominal computerized tomography (CT) scan results and between tumors of different grades and differentiation.

Results: Of the 20 patients studied, 11 (55%) had positive PET scans (PET score: 3 or 4) while nine (45%) were negative (PET score: 1 or 2). CT scan was positive in 18 patients (90%) and negative in two (10%). PET, however, revealed metastases in three patients that were not seen on CT. On pathological review, well-differentiated and low-grade tumors had lower PET scores. Comparison of the well-differentiated with the moderately- and poorly-differentiated tumors revealed a statistically significant difference. No statistical significance was observed between the moderately- and poorly-differentiated tumors or between different tumor grades and PET scores.

Conclusions: The sensitivity of PET in diagnosis of HCC was 55% compared to 90% for CT scanning, although only PET detected some tumors (including distant metastases). Well-differentiated and low tumor grades had lower activity on PET and correspondingly lower PET scores. PET imaging may help assess tumor differentiation and may be useful in the diagnosis and staging and prognostication of HCC as an adjunct to CT.

Section snippets

Materials and Methods

We conducted a retrospective chart review of patients with HCC seen at Saint Louis University Hospital who had both PET and computerized tomography (CT) scans done between 1995 and 1998. Serum aminotransferases, alpha-fetoprotein levels and serology for viral hepatitis (hepatitis B surface antigen, antibody to hepatitis B core antibody and antibody to hepatitis C virus) were recorded. The diagnosis of HCC was confirmed histologically or cytologically in all cases. Eleven patients had subsequent

Results

Twenty consecutive patients were studied including 15 males and five females ranging in age between 38 and 84 years (mean 60.1) (Table 1). Fifteen patients had cirrhosis. Three patients (18%) were sero-positive for anti-HCV, three for HBsAg (18%), while the viral status of three was not known. Serum alpha-fetoprotein levels were available on 18 patients and 12 of the 18 (67%) had levels above 10 ng/ml (mean 1646, range 20 to 14 427 ng/ml). The diagnosis of HCC was confirmed by histological (n

Discussion

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. The incidence is especially high in regions of Asia and sub-Saharan Africa although in the United States and Western Europe, HCC accounts for 1 to 2% of malignant tumors at autopsy (19). HCC often presents at an advanced stage when patients have abdominal pain or hepatic decompensation, although small tumors may be detected at an earlier stage by imaging techniques or by estimation of serum alpha-fetoprotein

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