Update on Positron Emission Tomography for Hepatocellular Carcinoma
SC Wong, WT Ngai, FPT Choi
Hong Kong J Radiol 2017;20:192-204
DOI: 10.12809/hkjr1716921
Hepatocellular carcinoma (HCC) is conventionally evaluated with ultrasonography, computed tomography, and magnetic resonance imaging. Positron emission tomography (PET) using the commonest radiotracer fluorine-18 fluorodeoxyglucose ([18F]FDG) has only a moderate sensitivity in detecting the primary tumour. This leads to the use of other radiotracers with better sensitivity for HCC, including carbon-11 acetate, carbon-11 choline, and fluorine-18 fluorocholine. PET using dual tracers (FDG complemented with a non-FDG tracer) can optimise the diagnostic performance. Although [18F]FDG PET has a limited role in detecting the primary tumour, it is more accurate in diagnosing extrahepatic metastases, which may affect treatment planning. Pre-treatment [18F]FDG PET also has a potential role in predicting prognosis and treatment outcomes, and supplementing established criteria to select patients for liver transplantation. Post-treatment PET may evaluate therapeutic response or detect tumour recurrence but supporting data remain relatively limited. There has been rapid advancement in the usage of PET for HCC; this warrants further prospective studies to confirm the role of PET in clinical management.
Authors’ affiliations:
SC Wong, WT Ngai, FPT Choi: Department of Nuclear Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
中文摘要
正電子發射斷層掃描用於肝細胞癌的更新
黃思進、魏偉達、蔡柏達
肝細胞癌（HCC）的成像評估通常通過超聲檢查、電腦斷層掃描和磁共振成像進行。在檢測原發 性HCC的應用上，正電子發射斷層掃描（PET）配合常用的氟-18氟脫氧葡萄糖（[18F]FDG）只有中 度的靈敏性，因此需要使用其他對HCC有較高靈敏性的放射性示蹤劑，包括碳-11乙酸酯、碳-11膽 鹼、氟-18氟膽鹼。組合性使用放射性示蹤劑能相互取長地提高PET在診斷HCC的成像精度。儘管 [18F]FDG PET對於原發性HCC檢測的價值有限，但對於檢測肝外轉移則具有較高的精確性，藉此或 能影響制訂治療方案。療前的[18F]FDG PET更在預測HCC患者的預後和治療結果具有潛在作用，亦 可能幫助選擇患者接受肝移植。療後PET可以監測HCC治療反應和檢測腫瘤復發，但確證的數據是 相對有限的。PET在HCC的應用迅速發展，有待進一步的前瞻性研究以確立其在臨牀治療過程中的 應用。