Talbot Jean-Noël, Gutman Fabrice, Fartoux Laetitia, Grange Jean-Didier, Ganne Nathalie, Kerrou Khaldoun, Grahek Dany, Montravers Françoise, Poupon Raoul, Rosmorduc Olivier
Department of Nuclear Medicine, Hôpital Tenon, AP-HP, et Université Pierre et Marie Curie, Paris, France.
Eur J Nucl Med Mol Imaging. 2006 Nov;33(11):1285-9. doi: 10.1007/s00259-006-0164-9. Epub 2006 Jun 27.
The diagnostic accuracy of [(18)F]fluorodeoxyglucose (FDG) PET is insufficient to characterise hepatocellular carcinoma (HCC) in liver masses and to diagnose all cases of recurrent HCC. HCC has been reported to take up [(11)C]acetate, but routine use of this tracer is difficult. Choline is another tracer of lipid metabolism, present in large amounts in HCC. In a proof-of-concept study, we evaluated [(18)F]fluorocholine (FCH) uptake by HCC and compared FCH PET/CT with FDG PET/CT.
Twelve patients with newly diagnosed (n=8) or recurrent HCC (n=4) were prospectively enrolled. HCC was assessed by histology in eight cases and by American Association for the Study of Liver Diseases (AASLD) criteria in four cases. All patients underwent whole-body PET/CT 10 min after injection of 4 MBq/kg FCH. Within 1 week, 9 of the 12 patients also underwent whole-body FDG PET/CT 1 h after injection of 5 MBq/kg FDG.
The per-patient analysis showed a detection rate of 12/12 using FCH PET/CT for both newly diagnosed and recurrent HCC. The median signal to noise ratio was 1.5+/-0.38. There was a trend towards a higher FCH SUV(max) in well-differentiated HCC (15.6+/-7.9 vs 11.9+/-0.9, NS). Of the nine patients who underwent FCH and FDG PET/CT, all nine were positive with FCH whereas only five were positive with FDG.
FCH provides a high detection rate for HCC, making it potentially useful in the initial evaluation of HCC or in the detection of recurrent disease. The favourable result of this proof-of-concept study opens the way to a phase III prospective study.
[（18）F]氟脱氧葡萄糖（FDG）PET的诊断准确性不足以对肝脏肿块中的肝细胞癌（HCC）进行特征性描述以及诊断所有复发性HCC病例。据报道，HCC可摄取[（11）C]乙酸盐，但该示踪剂的常规应用存在困难。胆碱是脂质代谢的另一种示踪剂，在HCC中大量存在。在一项概念验证研究中，我们评估了HCC对[（18）F]氟胆碱（FCH）的摄取情况，并将FCH PET/CT与FDG PET/CT进行了比较。
前瞻性纳入12例新诊断（n = 8）或复发性HCC（n = 4）患者。8例通过组织学评估HCC，4例根据美国肝病研究协会（AASLD）标准评估。所有患者在注射4 MBq/kg FCH后10分钟接受全身PET/CT检查。在1周内，12例患者中的9例在注射5 MBq/kg FDG后1小时还接受了全身FDG PET/CT检查。
每位患者的分析显示，FCH PET/CT对新诊断和复发性HCC的检出率均为12/12。中位信噪比为1.5±0.38。在高分化HCC中，FCH的SUV（max）有升高趋势（15.6±7.9 vs 11.9±0.9，无显著性差异）。在接受FCH和FDG PET/CT检查的9例患者中，9例FCH检查呈阳性，而FDG检查仅5例呈阳性。
FCH对HCC具有较高的检出率，使其在HCC的初始评估或复发性疾病检测中具有潜在应用价值。这项概念验证研究的良好结果为III期前瞻性研究开辟了道路。
