Can Dual Tracer 18F-FDG and 11C-Acetate PET Scan Predict Venous Permeation in Hepatocellular Carcinoma?

Abstract

Venous permeation was well known to be one of the poor prognostic indicators for hepatocellular carcinoma (HCC) recurrence in patient with liver transplantation. The only effective way of getting this information is to obtain a pathological diagnosis at the liver explants. Since 18F-FDG PET has insuffi cient sensitivity for the detection of HCC, 11C-acetate PET has been suggested as another technique for this use to increase the sensitivity. The objective of this study is to use dual tracer PET scan in patient with HCC to predict the presence of venous permeation. Methods: Between January 2004 and September 2009, we retrospectively reviewed fi fty-eight patients who had dual tracer whole body PET scan before operation. In this group of patients, 30 patients underwent hepatectomy and 28 underwent liver transplantation. The PET scans assessments of the liver tumours were verifi ed with the pathology and their prognostic signifi cance were investigated. Results: The sensitivity of 18F-FDG PET and 11C-acetate PET in detection of primary HCC were 60% and 93% respectively. Within the 58 patients, 29 patients were found to hav venous permeations in the final pathology. 35 patients were found to be 18F-FDG PET positive. The sensitivity, specifi city, positive predictive value and negative predictive value were 79%,58%, 65% and 73% respectively for venous permeation in HCC by 18F-FDG PET (p=0.003). 56 patients were found to be 11C-acetate positive. The sensitivity, specifi city, positive predictive value and negative predictive value were 89%,3.5%, 58% and 25% respectively for venous permeation in HCC by 11C-acetate PET (p=0.611). Other risk factors were analysed with positive PET result. Larger tumour size (>5cm) Stage III and IV HCC were significantly associated with positive 18F-FDG PET results (p=0.003 and p=0.011). However, the Uptake of 11C-acetate was not associated with the above mention poor prognostic indicators. Conclusion: The use of 18F-FDG PET before liver transplantation can predict the presence of venous permeation of HCC. The additional use of 11C-acetate can improve the overall sensitivity of the PET but it failed to demonstrate an additional value in prediction of venous permeation in HCC.