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

  • Published : 2016.07.01


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.



Supported by : Chulabhorn Hospital


  1. Bieze M, Klumpen HJ, Verheij J, et al (2014). Diagnostic accuracy of (18) F-methylcholine positron emission tomography/computed tomography for intra- and extrahepatic hepatocellular carcinoma. Hepatol, 59, 996-1006.
  2. Bolog N, Andreisek G, Oancea I, et al (2011). CT and MR imaging of hepatocellular carcinoma. J Gastrointestin Liver Dis, 20, 181-9.
  3. Bruix J, Sherman M, Practice Guidelines Committee AAftSoLD (2005). Management of hepatocellular carcinoma. Hepatol, 42, 1208-36.
  4. Castilla-Lievre MA, Franco D, Gervais P, et al (2016). Diagnostic value of combining C-choline and F-FDG PET/CT in hepatocellular carcinoma. Eur J Nucl Med Mol Imaging, 43, 852-9.
  5. Fartoux L, Balogova S, Nataf V, et al (2012). A pilot comparison of 18F-fluorodeoxyglucose and 18F-fluorocholine PET/CT to predict early recurrence of unifocal hepatocellular carcinoma after surgical resection. Nucl Med Commun, 33, 757-65.
  6. Glunde K, Bhujwalla ZM, Ronen SM (2011). Choline metabolism in malignant transformation. Nat Rev Cancer, 11, 835-48.
  7. Hara T, Kosaka N, Shinoura N, et al (1997). PET imaging of brain tumor with [methyl-11C]choline. J Nucl Med, 38, 842-7.
  8. Iwata Y, Shiomi S, Sasaki N, et al (2000). Clinical usefulness of positron emission tomography with fluorine-18- fluorodeoxyglucose in the diagnosis of liver tumors. Ann Nucl Med, 14, 121-6.
  9. Jeng LB, Changlai SP, Shen YY, et al (2003). Limited value of 18F-2-deoxyglucose positron emission tomography to detect hepatocellular carcinoma in hepatitis B virus carriers. Hepatogastroenterol, 50, 2154-6.
  10. Kanwal F, Befeler A, Chari RS, et al (2012). Potentially curative treatment in patients with hepatocellular cancer--results from the liver cancer research network. Aliment Pharmacol Ther, 36, 257-65.
  11. Kelloff GJ, Hoffman JM, Johnson B, et al (2005). Progress and promise of FDG-PET imaging for cancer patient management and oncologic drug development. Clin Cancer Res, 11, 2785-808.
  12. Khan MA, Combs CS, Brunt EM, et al (2000). Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol, 32, 792-7.
  13. Kolthammer JA, Corn DJ, Tenley N, et al (2011). PET imaging of hepatocellular carcinoma with 18F-fluoroethylcholine and 11C-choline. Eur J Nucl Med Mol Imaging, 38, 1248-56.
  14. Kuang Y, Salem N, Corn DJ, et al (2010). Transport and metabolism of radiolabeled choline in hepatocellular carcinoma. Mol Pharm, 7, 2077-92.
  15. Lin WY, Tsai SC, Hung GU (2005). Value of delayed 18F-FDGPET imaging in the detection of hepatocellular carcinoma. Nucl Med Commun, 26, 315-21.
  16. Lopci E, Torzilli G, Poretti D, et al (2015). Diagnostic accuracy of (1)(1)C-choline PET/CT in comparison with CT and/or MRI in patients with hepatocellular carcinoma. Eur J Nucl Med Mol Imaging, 42, 1399-407.
  17. Picchio M, Castellucci P (2012). Clinical indications of C-choline PET/CT in prostate cancer patients with biochemical relapse. Theranostics, 2, 313-7.
  18. Talbot JN, Fartoux L, Balogova S, et al (2010). Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med, 51, 1699-706.
  19. Talbot JN, Gutman F, Fartoux L, et al (2006). PET/CT in patients with hepatocellular carcinoma using [(18)F]fluorocholine: preliminary comparison with [(18)F]FDG PET/CT. Eur J Nucl Med Mol Imaging, 33, 1285-9.
  20. Teefey SA, Hildeboldt CC, Dehdashti F, et al (2003). Detection of primary hepatic malignancy in liver transplant candidates: prospective comparison of CT, MR imaging, US, and PET. Radiol, 226, 533-42.
  21. Wolfort RM, Papillion PW, Turnage RH, et al (2010). Role of FDG-PET in the evaluation and staging of hepatocellular carcinoma with comparison of tumor size, AFP level, and histologic grade. Int Surg, 95, 67-75.
  22. Wu HB, Wang QS, Li BY, et al (2011). F-18 FDG in conjunction with 11C-choline PET/CT in the diagnosis of hepatocellular carcinoma. Clin Nucl Med, 36, 1092-7.
  23. Yamamoto Y, Nishiyama Y, Kameyama R, et al (2008). Detection of hepatocellular carcinoma using 11C-choline PET: comparison with 18F-FDG PET. J Nucl Med, 49, 1245-8.