A dual-tracer approach using [11C]CH and [18F]FDG in HCC clinical decision making
Emile B Veenstra1, Simeon J S Ruiter2, Robbert J de Haas3
1Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. e.b.veenstra@umcg.nl.
Insights
Dual tracer PET/CT imaging using [11C]CH and [18F]FDG significantly improves the detection of recurrent hepatocellular carcinoma (HCC) in high-risk patients. This approach aids clinical decision-making when conventional imaging is inconclusive.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiology
Background:
- Early detection of recurrent or progressive hepatocellular carcinoma (HCC) is crucial for patient survival.
- Dual tracer positron emission tomography/computed tomography (PET/CT) using [11C]choline ([11C]CH) and [18F]fluorodeoxyglucose ([18F]FDG) targets different metabolic pathways in HCC.
- This study investigated the utility of dual-tracer PET/CT in managing patients with suspected recurrent or progressive HCC.
Purpose of the Study:
- To evaluate the effectiveness of dual-tracer ([11C]CH and [18F]FDG) PET/CT in detecting recurrent or progressive HCC.
- To assess the impact of dual-tracer PET/CT findings on clinical decision-making and treatment changes.
- To compare the detection rates of individual tracers and the combined dual-tracer approach.
Main Methods:
- Retrospective analysis of HCC patients who underwent both [11C]CH and [18F]FDG PET/CT between February 2018 and December 2021.
- Inclusion criteria: patients with unexplained suspicious CT/MRI or rising serum tumor markers, with at least 6-month follow-up.
- A lesion was considered critical if it led to treatment changes or had prognostic consequences.
Main Results:
- Nineteen patients were included; 13 had prior HCC treatment.
- The dual-tracer approach achieved a 95% critical finding detection rate.
- [18F]FDG detected 68% of findings, [11C]CH detected 84%, and both tracers identified 65% of intrahepatic recurrences.
Conclusions:
- Dual-tracer ([11C]CH and [18F]FDG) PET/CT is highly effective for staging high-risk HCC patients.
- This imaging modality offers superior detection rates compared to single tracers, especially for specific recurrence patterns.
- The study supports the adoption of dual-tracer PET/CT for improved HCC management when conventional imaging is inconclusive.
Background:
Early detection of recurrent or progressive HCC remains the strongest prognostic factor for survival. Dual tracer PET/CT imaging with [11C]CH and [18F]FDG can further increase detection rates as both tracers entail different metabolic pathways involved in HCC development. We investigated dual-tracer PET/CT in clinical decision making in patients suspected of recurrent or progressive HCC. All HCC patients who underwent both [11C]CH and [18F]FDG PET/CT in our institute from February 2018 to December 2021 were included. Both tracer PET/CT were within 4 weeks of each other with at least 6-month follow-up. Patients underwent dual tracer PET/CT because of unexplained and suspicious CT/MRI or sudden rise of serum tumour markers. A detected lesion was considered critical when the finding had prognostic consequences leading to treatment changes.
Results:
Nineteen patients who underwent [11C]CH and [18F]FDG PET/CT were included of which all but six patients were previously treated for HCC. Dual-tracer critical finding detection rate was 95%, with [18F]FDG 68%, and [11C]CH 84%. Intrahepatic HCC recurrence finding rate was 65% for both tracers. [18F]FDG found more ablation site recurrences (4/5) compared to [11C]CH (2/5). Only [11C]CH found two needle tract metastases. Both tracers found 75% of the positive lymph nodes. Two new primary tumours were found, one by [18F]FDG and both by [11C]CH.
Conclusions:
Our study favours a dual-tracer approach in HCC staging in high-risk patients or when conventional imaging is non-conclusive.
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