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Diagnosis of Hepatocellular Carcinoma Using C-11 Choline PET/CT: Comparison with F-18 FDG, Contrast-Enhanced MRI and MDCT

  • Chotipanich, Chanisa (National Cyclotron and PET Centre, Chulabhorn Hospital) ;
  • Kunawudhi, Anchisa (National Cyclotron and PET Centre, Chulabhorn Hospital) ;
  • Promteangtrong, Chetsadaporn (National Cyclotron and PET Centre, Chulabhorn Hospital) ;
  • Tungsuppawattanakit, Puntira (Medical Imaging Unit, Chulabhorn Hospital) ;
  • Sricharunrat, Thaniya (Pathology Unit, Chulabhorn Hospital) ;
  • Wongsa, Paramest (National Cyclotron and PET Centre, Chulabhorn Hospital)
  • Published : 2016.07.01

Abstract

Purpose: The aim of this study was to compare C-11 choline and F-18 FDG PET/CT, gadoxetic-enhanced 3-T MRI and contrast-enhanced CT for diagnosis of hepatocellular carcinoma (HCC). Materials and Methods: Twelve chronic hepatitis B patients suspected of having HCC by abdominal ultrasonography received all diagnostic modalities performed within a one-week timeslot. PET/CT results were analyzed visually by two independent nuclear medicine physicians and quantitatively by tumor to background ratio (T/B). Nine patients then had histopathological confirmation. Results: Six patients had well differentiated HCC, while two and one patient(s) were noted with moderately and poorly differentiated HCC, respectively. All were detected by both CT and MRI with an average tumor size of $5.7{\pm}3.8cm$. Five patients had positive C-11 choline and F-18 FDG uptake. Of the remaining four patients, three with well differentiated HCC showed negative F-FDG uptake (one of which showed negative results by both tracers) and one patient with moderately differentiated HCC demonstrated no C-11 choline uptake despite intense F-18 FDG avidity. The overall HCC detection rates with C-11 choline and F-18 FDG were 78% and 67%, respectively, while the sensitivity of F-18 FDG for non-well differentiated HCC was 100%, compared with 83% of C-11 choline. The average T/B of C-11 choline in well-differentiated HCC patients was higher than in moderately and poorly differentiated cases (p=0.5) and vice versa with statistical significance for T/B of F-18 FDG (p = 0.02). Conclusions: Our results suggested better detection rate in C-11 choline for well differentiated HCC than F-18 FDG PET. However, the overall detection rate of PET/CT with both tracers could not compare with contrast-enhanced CT and MRI.

Keywords

HCC;diagnopsis;PET/CT;choline;FDG;MRI;CT

Acknowledgement

Supported by : Chulabhorn Hospital

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