Adding 11C-acetate to 18F-FDG at PET Examination Has an Incremental Value in the Diagnosis of Hepatocellular Carcinoma

Patricia Larsson, Dag Arvidsson, Mikael Björnstedt, Bengt Isaksson, Ulf Jersenius, Hooman Motarjemi, Hans Jacobsson, Patricia Larsson, Dag Arvidsson, Mikael Björnstedt, Bengt Isaksson, Ulf Jersenius, Hooman Motarjemi, Hans Jacobsson

Abstract

Objective: The sensitivity of FDG at PET examination of Hepatocellular Carcinoma (HCC) is restricted. In a few studies, all done in Oriental patients, PET-examination with (11)C-acetate has shown a higher accuracy than with FDG. In the current study, the uptake of (11)C-acetate has been compared with the uptake of FDG in the primary HCC in a cohort of Occidental patients.

Material and methods: 44 patients underwent PET-examination with both tracers with a mean of 9 days between the examinations. 26 patients had a microscopical diagnosis and 18 were diagnosed with multimodal radiological methods. At least one relevant radiological examination was available for comparison.

Results: At visual evaluation, 13 of the HCC's were positive at PET-examination using FDG and 34 were positive using (11)C-acetate (p<0.001). Median tumor SUVmean of (11)C-acetate was 4.7 and of FDG was 1.9 (p<0.001). There was also a higher uptake of (11)C-acetate by the surrounding liver tissue than of FDG. Median liver SUVmean of [u]11[/u]C-acetate was 3.2 and of FDG it was 1.7 (p<0.001). This corresponded to a median tumour/liver tissue ratio for (11)C-acetate of 1.4 and for FDG of 1.0 (p<0.05). Previous reports of a negative correlation between the uptake of the tracers were weakly supported. In 4 large tumors some portions being hot using one of the tracers were cold using the other tracer and vice versa.

Conclusion: Adding registration with (11)C-acetate to registration with FDG at PET-examination has an incremental value in the diagnosis of HCC. A higher tumor uptake of (11)C-acetate cannot be taken full advantage of because of a higher uptake also by the surrounding liver tissue.

Conflict of interest: None declared.

Keywords: (11C)-acetate; 18F-FDG; Hepatocellular carcinoma; positron-emission; sensitivity; tomography.

Figures

Figure 1. PET examinations (A-P MIP’s) with…
Figure 1. PET examinations (A-P MIP’s) with FDG (A) and 11C-acetate (B) ina 58-year old woman with a large HCC (arrows). This illustrates theparadoxical effect of the higher uptake of 11C-acetate by the surroundingliver tissue compared to the uptake of FDG. In this patient, the tumorSUVmean was 3.2 for both tracers. SUVmean for FDG of surrounding liver tissue (A)was 1.1 and SUVmean for 11C-acetate (B) was 2.6. Thiscorresponded to tumor-to-background ratios of 3.0 and 1.2, respectively
Figure 2. Transversal sections at the same…
Figure 2. Transversal sections at the same level from PET examinationswith FDG (A) and 11C-acetate (B) in a 76-year old woman with a large HCCdiagnosed according to the Barcelona criteria. The figure illustrates adiscordant uptake between the two tracers. Red delineates the 50% isocontourlevel of FDG and blue delineates the 50% isocontour level of 11C-acetate
Figure 3. Transversal sections at the same…
Figure 3. Transversal sections at the same level from PET examinationswith FDG (A) and 11C-acetate (B) in a 70-year old man with a large, well differentiatedHCC confirmed at histopathology after surgical resection.The figure illustrates a discordant uptake between the two tracers. Reddelineates the 50% isocontour level of FDG and blue delineates the 50%isocontour level of 11C-acetate

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