[FDG-PET in hepatocellular carcinoma. Based on one case]

Area of Science:

• Hepatobiliary Medicine
• Diagnostic Imaging
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a primary liver cancer with significant global health implications.
• Accurate and timely diagnosis is crucial for effective patient management and treatment.
• Positron Emission Tomography-Fluorodeoxyglucose (PET-FDG) is a widely used imaging modality in oncology.

Observation:

• A 73-year-old male presented with rapid weight loss, abdominal pain, and progressive hepatic failure.
• Initial imaging (MRI, liver ultrasound) suggested hepatocellular carcinoma versus liver metastases.
• PET-FDG imaging revealed hepatomegaly and splenomegaly with homogeneous tracer distribution in the liver.

Findings:

• Liver biopsy confirmed hepatocellular carcinoma as the final diagnosis.
• The homogeneous FDG uptake in the liver limited the diagnostic sensitivity of PET-FDG for this specific HCC case.
• PET-FDG detects only 50-70% of HCCs, often due to variable glucose-6-phosphatase activity within tumors.

Implications:

• This case underscores the limitations of PET-FDG in diagnosing certain types of hepatocellular carcinoma.
• Highlights the importance of integrating clinical presentation, conventional imaging, and biopsy for accurate HCC diagnosis.
• Emphasizes the need for further research into advanced imaging techniques for improved HCC detection.