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Nuclear Medicine and Molecular Imaging

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01.06.2012 | Original Article

Usefulness of F-18 FDG PET/CT in the Evaluation of Early Treatment Response After Interventional Therapy for Hepatocellular Carcinoma

verfasst von: Sung Hoon Kim, Kyoung Sook Won, Byung Wook Choi, Il Jo, Seok Kil Zeon, Woo Jin Chung, Jung Hyeok Kwon

Erschienen in: Nuclear Medicine and Molecular Imaging | Ausgabe 2/2012

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Abstract

Purpose

This retrospective study investigated the usefulness of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) after interventional therapy for hepatocellular carcinoma (HCC).

Methods

Between March 2007 and November 2010, 31 patients (24 men, 7 women; mean age, 61.8 ± 11.0 years) with 45 lesions underwent PET/CT within 1 month after interventional therapy for HCC. Twenty-six patients with 40 lesions underwent transcatheter arterial chemoembolization (TACE), two patients with 2 lesions underwent radiofrequency ablation (RFA), and three patients with 3 lesions underwent percutaneous ethanol injection therapy (PEIT). Patients with a history of previous interventional therapy were excluded. Visual analysis was graded as positive when FDG was observed as an eccentric, nodular, or infiltrative pattern, and negative in case of isometabolic, hypometabolic, or rim-shaped uptake. For quantitative analysis, the standardized uptake value (SUV) was measured by region of interest technique. Maximum SUV (SUVmax) was assessed, and the ratio of SUVmax of tumor to mean SUV of normal liver (TNR) was calculated. The patients were divided into two groups, with and without residual tumor, based on 6-month clinical follow-up with serum alpha-fetoprotein and contrast-enhanced abdominal CT.

Results

Of the 45 lesions, 24 were classified in the residual tumor group and the other 21 lesions in the no residual tumor group. No residual tumor was detected after RFA or PEIT. By visual analysis, the respective values for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.5, 71.4, 77.8, 83.3, and 80.0 %. However, there were no significant differences in the SUVmax and TNR between the two groups.

Conclusions

It is suggested that FDG PET/CT may play a role in the evaluation of early treatment response after interventional therapy for HCC. The results indicate that FDG PET/CT visual analysis may be more useful than quantitative analysis. Further prospective studies with a large number of patients and established protocol are needed to substantiate our results.

Röcken C, Carl-McGrath S. Pathology and pathogenesis of hepatocellular carcinoma. Dig Dis. 2001;19:269–78.PubMedCrossRef

Higashi T, Hatano E, Ikai I, Nishii R, Nakamoto Y, Ishizu K, et al. FDG PET as a prognostic predictor in the early post-therapeutic evaluation for unresectable hepatocellular carcinoma. Eur J Nucl Med Mol Imaging. 2010;37:468–82.PubMedCrossRef

Poon RT, Fan ST, Tsang FH, Wong J. Locoregional therapies for hepatocellular carcinoma: a critical review from the surgeon's perspective. Ann Surg. 2002;235:466–86.PubMedCrossRef

Thabet A, Kalva S, Gervais DA. Percutaneous image-guided therapy of intra-abdominal malignancy: imaging evaluation of treatment response. Abdom Imaging. 2009;34:593–609.PubMedCrossRef

Rampone B, Schiavone B, Martino A, Viviano C, Confuorto G. Current management strategy of hepatocellular carcinoma. World J Gastroenterol. 2009;15:3210–6.PubMedCrossRef

Kwon JH. Is percutaneous ethanol injection therapy still effective for hepatocellular carcinoma in the era of radiofrequency ablation? Gut Liver. 2010;4:S105–12.PubMedCrossRef

Livraghi T. Radiofrequency ablation, PEIT, and TACE for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2003;10:67–76.PubMed

Lim HK, Han JK. Hepatocellular carcinoma: evaluation of therapeutic response to interventional procedures. Abdom Imaging. 2002;27:168–79.PubMedCrossRef

Kim KW, Lee JM, Choi BI. Assessment of the treatment response of HCC. Abdom Imaging. 2011;36:300–14.PubMedCrossRef

10.

Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30:52–60.PubMedCrossRef

11.

Kim HO, Kim JS, Shin YM, Ryu JS, Lee YS, Lee SG. Evaluation of metabolic characteristics and viability of lipiodolized hepatocellular carcinomas using ¹⁸F-FDG PET/CT. J Nucl Med. 2010;51:1849–56.PubMedCrossRef

12.

Paudyal B, Oriuchi N, Paudyal P, Tsushima Y, Iida Y, Higuchi T, et al. Early diagnosis of recurrent hepatocellular carcinoma with ¹⁸F-FDG PET after radiofrequency ablation therapy. Oncol Rep. 2007;18:1469–73.PubMed

13.

Kim YK, Lee KW, Cho SY, Han SS, Kim SH, Kim SK, et al. Usefulness ¹⁸F-FDG positron tomography/computed tomography for detecting recurrence of hepatocellular carcinoma in posttransplant patients. Liver Transpl. 2010;16:767–72.PubMedCrossRef

14.

Trojan J, Schroeder O, Raedle J, Baum RP, Herrmann G, Jacobi V, et al. Fluorine-18 FDG positron emission tomography for imaging of hepatocellular carcinoma. Am J Gastroenterol. 1999;94:3314–9.PubMedCrossRef

15.

Khan MA, Combs CS, Brunt EM, Lowe VJ, Wolverson MK, Solomon H, et al. Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol. 2000;32:792–7.PubMedCrossRef

16.

Sun L, Wu H, Guan YS. Positron emission tomography/computer tomography: challenge to conventional imaging modalities in evaluating primary and metastatic liver malignancies. World J Gastroenterol. 2007;13:2775–83.PubMed

17.

Sun L, Guan YS, Pan WM, Luo ZM, Wei JH, Zhao L, et al. Metabolic restaging of hepatocellular carcinoma using whole-body ¹⁸F-FDG PET/CT. World J Hepatol. 2009;31:90–7.CrossRef

18.

Torizuka T, Tamaki N, Inokuma T, Magata Y, Yonekura Y, Tanaka A, et al. Value of fluorine-18-FDG-PET to monitor hepatocellular carcinoma after interventional therapy. J Nucl Med. 1994;35:1965–9.PubMed

19.

Kim JW. Diagnosis of hepatocellular carcinoma. J Kor Liver Cancer Study Group. 2010;10:1–5.

20.

Lammertsma AA, Hoekstra CJ, Giaccone G, Hoekstra OS. How should we analyse FDG PET studies for monitoring tumour response? Eur J Nucl Med Mol Imaging. 2006;33:S16–21.CrossRef

21.

Seo S, Hatano E, Higashi T, Hara T, Tada M, Tamaki N, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography predicts tumor differentiation, P-glycoprotein expression, and outcome after resection in hepatocellular carcinoma. Clin Cancer Res. 2007;13:427–33.PubMedCrossRef

22.

Imperiale A, Federici L, Lefebvre N, Braun JJ, Pfumio F, Kessler R, et al. F-18 FDG PET/CT as a valuable imaging tool for assessing treatment efficacy in inflammatory and infectious diseases. Clin Nucl Med. 2010;35:86–90.PubMedCrossRef

23.

Veit P, Antoch G, Stergar H, Bockisch A, Forsting M, Kuehl H. Detection of residual tumor after radiofrequency ablation of liver metastasis with dual-modality PET/CT: initial results. Eur Radiol. 2006;16:80–7.PubMedCrossRef

24.

Purandare NC, Rangarajan V, Shah SA, Sharma AR, Kulkarni SS, Kulkarni AV, et al. Therapeutic response to radiofrequency ablation of neoplastic lesions: FDG PET/CT findings. Radiographics. 2011;31:201–13.PubMedCrossRef

25.

Becker CD, Grossholz M, Mentha G, Roth A, Giostra E, Schneider PA, et al. Ablation of hepatocellular carcinoma by percutaneous ethanol injection: imaging findings. Cardiovasc Intervent Radiol. 1997;20:204–10.PubMedCrossRef

26.

Jiang B, Lou Q, Ding XF, Sa XY, Chen LR, Yu SY, et al. Histopathological changes in rat transplanted hepatoma after lipiodol transarterial embolization. Zhonghua Zhong Liu Za Zhi. 2004;26:205–8.PubMed

27.

Zhao M, Wu PH, Zeng YX, Zhang FJ, Huang JH, Fan WJ, et al. Evaluating efficacy of transcatheter arterial chemo-embolization combined with radiofrequency ablation on patients with hepatocellular carcinoma by ¹⁸FDG-PET/CT. Ai Zheng. 2005;24:1118–23.PubMed

28.

Lokken RP, Gervais DA, Arellano RS, Tuncali K, Morrison PR, Tatli S, et al. Inflammatory nodules mimic applicator track seeding after percutaneous ablation of renal tumors. AJR Am J Roentgenol. 2007;189:845–8.PubMedCrossRef

29.

Khandani AH, Calvo BF, O'Neil BH, Jorgenson J, Mauro MA. A pilot study of early ¹⁸F-FDG PET to evaluate the effectiveness of radiofrequency ablation of liver metastases. AMJ Am J Roentgenol. 2007;189:1199–202.CrossRef

30.

Heusner TA, Fronz U, Jentzen W, Verhagen R, Forsting M, Bockisch A, et al. The effect of different chemoembolization materials on CT-based attenuation correction in PET/CT. Rofo. 2007;179:1159–65.PubMedCrossRef

31.

Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics. 1999;19:61–77.PubMed

32.

Sturgeon CM, Duffy MJ, Hofmann BR, Lamerz R, Fritsche HA, Gaarenstroom K, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in liver, bladder, cervical, and gastric cancers. Clin Chem. 2010;56:e1–48.PubMedCrossRef

33.

Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL Conference. J Hepatol. 2001;35:421–30.PubMedCrossRef

34.

Benson 3rd AB, Abrams TA, Ben-Josef E, Bloomston PM, Botha JF, Clary BM, et al. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw. 2009;7:350–91.PubMed

35.

Giovannini M, Elias D, Monges G, Raoul JL, Rougier P. Hepatocellular carcinoma. Br J Cancer. 2001;84:74–7.PubMedCrossRef

36.

Leung TWT, Patt YZ, Lau WY, Ho SKW, Yu SCH, Chan ATC, et al. Complete pathological remission is possible with systemic combination chemotherapy for inoperable hepatocellular carcinoma. Clin Cancer Res. 1999;5:1676–81.PubMed

37.

Lee JK, Chung YH, Song BC, Shin JW, Choi WB, Yang SH, et al. Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization. J Gastroenterol Hepatol. 2002;17:52–8.PubMedCrossRef

Titel: Usefulness of F-18 FDG PET/CT in the Evaluation of Early Treatment Response After Interventional Therapy for Hepatocellular Carcinoma
verfasst von: Sung Hoon Kim
Kyoung Sook Won
Byung Wook Choi
Il Jo
Seok Kil Zeon
Woo Jin Chung
Jung Hyeok Kwon
Publikationsdatum: 01.06.2012
Verlag: Springer-Verlag
Erschienen in: Nuclear Medicine and Molecular Imaging / Ausgabe 2/2012
Print ISSN: 1869-3474
Elektronische ISSN: 1869-3482
DOI: https://doi.org/10.1007/s13139-012-0138-8

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

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