valueofpet-ctinhepatocellularcarcinoma.pptVIP

JHSGR 16th April 2011 Dr Lee Man Kit Derek The value of PET in staging adenocarcinoma e.g. colorectal cancer is well established Tomoharu T. et al. The American J of Surg. 2002; 184: 433-436  Not as straight forward as other tumors in knowing where PET-CT fits into management HCC accumulate FDG to varying degrees Conventional F-FDG PET has a high average false-negative rate of 40-50% in the detection of HCC Delbeke et al. Arch Surg. 1998;133:510-515 Khan et al. J Hepatol. 2000;32:792-797 Okazumi et al. J Nucl Med. 1992;33:333-339 Questions to be answered: Ability to differentiate benign and malignant liver lesions Detection of intra-hepatic tumors +/-metastasis Detection of extra-hepatic metastasis Recent studies suggested the use of another tracer, C-acetate, in conjunction with F-FDG to increase the detection rate of HCC The degree of HCC differentiation determines its relative avidity for one of the two probe molecules Ho et al. F-FDG C-acetate Well differentiated HCC - + Poorly differentiated HCC + - C-acetate is able to detect the entire proportion of HCC lesions that are negative on F-FDG imaging Tumors that are both positive on C-acetate and F-FDG are taken up by different parts of tumors Well differentiated HCC Poorly differentiated HCC Moderately differentiated HCC Dual-tracers PET are complementary to each other in the detection of HCC The addition of C-acetate to F-FDG PET-CT increases the overall sensitivity for the detection of primary HCC Park et al. F-FDG C-acetate Dual tracer Sensitivity % 60.9 75.4 82.7 Dual-tracers PET can be quite specific for HCC Ho et al. Useful in the preliminary evaluation of unknown liver masses C-acetate F-FDG + + HCC is likely - + Non HCC malignancy or poorly differentiated HCC - - Benign pathology is more likely Although dual-tracers PET has a high sensitivity in detecting HCC Limitation in diagnosing small tumor 2cm HCC Park et al. Dual tracer PET-CT appear not to be useful for the detection of sma