Impact of the 18F-FDG-PET/MRI on Metastatic Staging in Patients with Hepatocellular Carcinoma: Initial Results from 104 Patients
Mathilde Vermersch, Sébastien Mulé, Julia Chalaye, Athena Galletto Pregliasco, Berivan Emsen, Giuliana Amaddeo, Aurélien Monnet, Alto Stemmer, Laurence Baranes, Alexis Laurent, Vincent Leroy, Emmanuel Itti, Alain Luciani, Mathilde Vermersch, Sébastien Mulé, Julia Chalaye, Athena Galletto Pregliasco, Berivan Emsen, Giuliana Amaddeo, Aurélien Monnet, Alto Stemmer, Laurence Baranes, Alexis Laurent, Vincent Leroy, Emmanuel Itti, Alain Luciani
Abstract
Optimal HCC therapeutic management relies on accurate tumor staging. Our aim was to assess the impact of 18F-FDG-WB-PET/MRI on HCC metastatic staging, compared with the standard of care CT-CAP/liver MRI combination, in patients with HCC referred on a curative intent or before transarterial radioembolization. One hundred and four consecutive patients followed for HCC were retrospectively included. The WB-PET/MRI was compared with the standard of care CT-CAP/liver MRI combination for HCC metastatic staging, with pathology, followup, and multidisciplinary board assessment as a reference standard. Thirty metastases were identified within 14 metastatic sites in 11 patients. The sensitivity of WB-PET/MRI for metastatic sites and metastatic patients was significantly higher than that of the CT-CAP/liver MRI combination (respectively 100% vs. 43%, p = 0.002; and 100% vs. 45%, p = 0.01). Metastatic sites missed by CT-CAP were bone (n = 5) and distant lymph node (n = 3) in BCLC C patients. For the remaining 93 nonmetastatic patients, three BCLC A patients identified as potentially metastatic on the CT-CAP/liver MRI combination were correctly ruled out with the WB-PET/MRI without significant increase in specificity (100% vs. 97%; p = 0.25). The WB-PET/MRI may improve HCC metastatic staging and could be performed as a "one-stop-shop" examination for HCC staging with a significant impact on therapeutic management in about 10% of patients especially in locally advanced HCC.
Keywords: 18F-Fluoro-Desoxy-Glucose; PET/MRI; hepatocellular carcinoma; metastases; staging.
Conflict of interest statement
Two authors (Aurélien Monnet and Alto Stemmer) are employees of Siemens Healthineers. Both authors enabled the optimization of whole-body MR protocols on our PET/MR system for this study. All other authors retained full control of all data and were responsible for all analyses performed in the study. The study did not receive any financial support from industry.
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