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      A 18F-FDG PET/CT Screening Study of a Hepatocellular Carcinoma Patient with Diffuse 18F-FDG Uptake into the Portal Vein and its Intrahepatic Branches

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          Abstract

          Major vascular invasion is one of the worst prognostic factors of hepatocellular carcinoma (HCC). Fludeoxyglucose F 18 ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) method is succesfully being used in HCC patients for the detection of particularly long-distance metastasis. Major vascular invasion is shown by radiological methods [particularly dynamic CT and/or magnetic resonance imaging (MRI)]. A male patient aged 60 years was diagnosed with HCC, according to biopsy after the detection of a mass in the liver. His medical examinations that were performed for the evaluation in terms of liver transplantation were dynamic CT and dynamic MRI; invasion in the intrahepatic branches of the portal vein and in main portal vein was also detected. PET/CT was performed to investigate the distant metastases. Moreover, diffuse 18 F-FDG uptake in the intrahepatic branches of the portal vein and in the main portal vein was observed.

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          Microvascular invasion in patients with hepatocellular carcinoma and its predictable clinicopathological factors.

          Nobuyoshi Fukushima, Eiji Ando, RYOKO KUROMATSU … (2008)
          Macroscopic vascular invasion is known to be a poor prognostic factor in hepatocellular carcinoma (HCC). The aim of this study was to determine the outcomes and predictive factors after hepatic resection for HCC with microvascular invasion (MVI). One hundred ten patients who underwent curative resection for HCC without macroscopic vascular invasion were included in this retrospective study. The risk factors of these patients for recurrence-free and disease-specific survival were investigated, and the clinicopathological factors predicting the presence of MVI were also determined. Of the 110 resected specimens, 49 (45%) had evidence of MVI. By univariate analysis, MVI was found to be statistically significantly associated with greater tumor size, gross classification, histological grade, and intrahepatic micrometastasis. Gross classification proved to be the only independent predictive factor for MVI by multiple logistic regression analysis. By multivariate analysis, cirrhosis and MVI were identified as independent risk factors for recurrence-free survival. The 5-year recurrence-free survival rates for patients with and without MVI were 20.8% and 52.6%, respectively. By multivariate analysis, the number of tumors, presence of MVI, and intrahepatic micrometastasis were identified as independent predictors of disease-specific survival. The 5-year disease-specific survival rates for patients with and without MVI were 59.3% and 92.0%, respectively. The presence of MVI was the most important risk factor affecting recurrence and survival in HCC patients after curative resection. Furthermore, this study showed that gross classification of HCC can be very helpful in predicting the presence of MVI.
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            Dual-tracer PET/CT imaging in evaluation of metastatic hepatocellular carcinoma.

            Po-Lai Ho, V Cheng, Henry Yeung … (2007)
            We have reported previously that (11)C-acetate ((11)C-ACT) PET was complementary to (18)F-FDG PET in the evaluation of primary hepatocellular carcinoma (HCC) in relation to the degree of tumor cellular differentiation. In this retrospective study, our goals were to further explore the complementary role of (11)C-ACT and (18)F-FDG PET in the detection of metastatic HCC disease, to evaluate the tracer characteristics of individual organ metastasis, to identify the risk factors of metastasis, and to evaluate how these results could affect patient management. One hundred twenty-one patients were selected for this study. All patients had undergone a "dual-tracer" PET/CT same-day protocol with (11)C-ACT PET/CT followed by (18)F-FDG PET/CT. Sets of criteria were chosen to define "metastasis" and "no metastasis" on a patient basis. The patients considered as true-positive (n = 97) were then divided into 4 groups on the basis of their primary HCC tracer avidity: (18)F-FDG-avid group, (11)C-ACT-avid group, (18)F-FDG- and (11)C-ACT-avid group, and a posttreatment group with metastasis but no baseline dual-tracer PET characterization of the primary tumor and no hepatic recurrence. On a patient basis, dual-tracer PET/CT had a sensitivity of 98%, a specificity of 86%, a positive predictive value of 97%, a negative predictive value of 90%, and an accuracy of 96% in the detection of HCC metastasis. On a lesion basis, 273 metastatic HCC lesions considered as true-positive were detected and categorized according to the organ or site of metastasis: lymph node (abdominal and thoracic, 49%), lung (32%), bone (8%), and others (10%). The lesion-based and patient-based detection sensitivities were 60% and 64%, respectively, by (11)C-ACT and 77% and 79%, respectively, by (18)F-FDG, and they were complementary. In analyzing lesion tracer avidity, there was a positive statistical correlation between primary HCC avidity with the general tendency of metastasis. Clinically significant changes in management were found in patients with true-positive metastasis, of whom 19% were affected by (11)C-ACT PET alone. Dual-tracer PET/CT was more effective than single-tracer PET/CT in identifying candidates for curative therapy (negative predictive value of dual-tracer, (18)F-FDG, and (11)C-ACT PET/CT: 90%, 49%, and 37%, respectively). This study confirmed that (18)F-FDG PET/CT is useful in the evaluation of HCC metastasis, although its role in the diagnosis of primary HCC is more limited. Dual-tracer PET/CT had an incremental value and complementary advantage when compared with single-tracer imaging in the evaluation of HCC metastasis.
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              Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver.

              M. Rode, B Bancel, P Douek … (2015)
              The purpose of this work was to evaluate the detection and characterization of nodules > or = 8 mm and small hepatocellular carcinomas (HCCs) in liver cirrhosis. Pathologic examination and results of US, helical CT, and dynamic MRI with gadolinium were compared after orthotopic liver transplantation (OLT) of 43 cirrhotic patients. Nodules were classified as macroregenerative nodules (MRNs), borderline nodules (BNs), and HCC. Pathologic examination classified 69 nodules: 50 MRNs, 6 BNs, and 13 HCCs. Sensitivities of MRN, BN, and HCC detection were, respectively, for US imaging 2% (1/50), 33.3% (2/6), and 46.2% (6/13); for helical CT 2% (1/50), 50% (3/6), and 53.8% (7/13); and for MRI 42% (21/50), 50% (3/6), and 76.9% (10/13). MRI detected 21 MRNs. They presented on T1/T2-weighted images as hyperintense/hypointense (n = 8), hyperintense/isointense (n = 7), hypointense/hypointense (n = 4), hypointense/isointense (n = 1), and hypointense depicted only on echo planar imaging (n = 1). The three detected BNs were hyperintense/hypointense nodules. The 10 detected HCCs appeared hyperintense/isointense (n = 7), hyperintense/hypointense (n = 2), and hypointense/isointense (n = 1). None of the MRNs but eight HCCs and one BN were enhanced after gadolinium injection. Contrast-enhanced MRI is the most sensitive technique for detecting liver nodules. No MR signal intensity pattern characteristic of small HCCs enables differentiation from benign nodules, however. Gadolinium enhancement is the most sensitive and specific characteristic of HCC.
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Nucl Med
                Journal ID (iso-abbrev): World J Nucl Med
                Journal ID (publisher-id): WJNM
                Title: World Journal of Nuclear Medicine
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1450-1147
                ISSN (Electronic): 1607-3312
                Publication date (Print): Jan-Apr 2016
                Volume: 15
                Issue: 1
                Pages: 68-70
                Affiliations
                [1]Department of Nuclear Medicine, Karabuk University, Karabuk, Turkey
                [1 ]Department of Nuclear Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
                [2 ]Department of Anesthesiology, Yildirim Beyazit University, Training and Research Hospital, Ankara, Turkey
                [3 ]Department of Radiology, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
                Author notes
                Address for correspondence: Dr. Reyhan Koroglu, Department of Nuclear Medicine, Faculty of Medicine, Karabuk University, Karabuk, Turkey. E-mail: reyhankoroglu@ 123456yahoo.com
                Article
                Publisher ID: WJNM-15-68
                DOI: 10.4103/1450-1147.167590
                PMC ID: 4729021
                PubMed ID: 26912985
                SO-VID: 277773b7-9b38-44f8-9147-54fc76154f8e
                Copyright © Copyright: © World Journal of Nuclear Medicine
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Categories
                Subject: Case Report

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: diffuse fludeoxyglucose f 18 (18 f-fdg) uptake,hepatocellular carcinoma (hcc),intrahepatic branches of the portal vein
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: diffuse fludeoxyglucose f 18 (18 f-fdg) uptake, hepatocellular carcinoma (hcc), intrahepatic branches of the portal vein

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