European Journal of Nuclear Medicine and Molecular Imaging

, Volume 38, Issue 6, pp 1037–1045

18F-FDG PET independently predicts survival in patients with cholangiocellular carcinoma treated with 90Y microspheres


    • Department of Nuclear MedicineLudwig-Maximilians-University
    • Department of Nuclear MedicineKlinikum Grosshadern
  • Volker Heinemann
    • Department of Internal Medicine IIILudwig-Maximilians-University
  • Christiane J. Bruns
    • Department of SurgeryLudwig-Maximilians-University
  • Ralf Hoffmann
    • Institute of Clinical RadiologyLudwig-Maximilians-University
  • Tobias Jakobs
    • Institute of Clinical RadiologyLudwig-Maximilians-University
  • Peter Bartenstein
    • Department of Nuclear MedicineLudwig-Maximilians-University
  • Marcus Hacker
    • Department of Nuclear MedicineLudwig-Maximilians-University
Original Article

DOI: 10.1007/s00259-011-1736-x

Cite this article as:
Haug, A.R., Heinemann, V., Bruns, C.J. et al. Eur J Nucl Med Mol Imaging (2011) 38: 1037. doi:10.1007/s00259-011-1736-x



90Y radioembolization has emerged as a valuable therapy for intrahepatic cholangiocellular carcinomas (ICC). We aimed to evaluate the prognostic power of FDG PET/CT and that of pretherapeutic scintigraphy with 99mTc-labelled macroagglutinated albumin (MAA), an index of tumour vascularization.


The study group comprised 26 consecutive patients suffering from nonresectable ICC. Before treatment with radioembolization, all patients underwent MRI of the liver, as well as MAA scintigraphy, which was followed immediately by SPECT(/CT) to quantify the liver–lung shunt fraction. Using image fusion, regions of interest were drawn around the tumours and the entire liver, and the tumour-to-liver quotient was calculated. In addition, FDG PET/CT was performed at baseline and 3 months after radioembolization, and the percentage changes in peak (ΔSUVmax) and mean (ΔSUVmean) FDG uptake and in metabolic tumour volume (ΔVol2SD) relative to baseline were calculated. Treatment response at 3 months was also assessed using contrast-enhanced MRI and CT on the basis of standard criteria.


Of 23 patients in whom follow-up MRI was available, 5 (22%) showed a partial response, 15 (65%) stable disease and 3 (13%) progressive disease. The change in all FDG values significantly predicted survival by Kaplan-Meier analysis after radioembolization; ΔVol2SD responders had a median survival of 97 weeks versus 30 weeks in nonresponders (P = 0.02), whereas ΔSUVmax and ΔSUVmean responders had a median survival of 114 weeks (responder) versus 19 weeks (nonresponder) and 69 weeks in patients with stable disease (P < 0.05). Pretherapeutic MAA scintigraphy or MRI did not predict survival, nor did the presence of extrahepatic metastases, or prior therapies. Only ΔVol2SD was significantly associated with survival by univariate analysis (hazard ratio 0.25; P = 0.04) and multivariate analysis (hazard ratio 0.20, P = 0.04).


FDG PET/CT was able to predict patient outcome after radioembolization treatment, with the change in metabolically active tumour volume at 3 months being the best independent predictor. High tumour vascularization, as indicated by MAA scintigraphy, was not a prerequisite for successful radioembolization and was even associated with a tendency towards shorter survival.


RadioembolizationIntrahepatic cholangiocellular carcinomaFDG PET/CTMAA scintigraphy

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© Springer-Verlag 2011