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Diagnostic accuracy of 11C-choline PET/CT in comparison with CT and/or MRI in patients with hepatocellular carcinoma

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Abstract

Purpose

In recent decades, the use of radiopharmaceuticals in the assessment of hepatocellular carcinoma (HCC) has become established, and new findings indicate that radiolabelled choline has considerable potential in this setting. Therefore, in this study we aimed to assess the diagnostic role of 11C-choline positron emission tomography (PET)/CT, compared with conventional imaging with CT/MRI, in patients with HCC.

Methods

The study population comprised 45 patients (male to female ratio = 37:8, median age 70.5 years) referred to our institution owing to HCC: 27 at initial diagnosis and 18 for restaging after recurrence. In all cases we performed whole-body 11C-choline PET/CT and compared its findings with contrast-enhanced CT (n = 35) or MRI (n = 29) or both (n = 15) for a total of 50 paired scans. The reference standard was either histological proof (21 patients) or a multidisciplinary consensus. Diagnostic accuracy was then determined in a scan-based (SBA) and a lesion-based analysis (LBA).

Results

On SBA the sensitivity and specificity for PET were 88 and 90 %, respectively, whereas for CT/MRI they were 90 and 73 %, respectively (p > 0.05). On LBA the overall sensitivity and specificity were 78 and 86 %, respectively, for PET vs 65 and 55 % for CT/MRI. Overall we investigated 168 disease sites, of which 100 were in the liver and 68 were extrahepatic. When considering only liver lesions, 11C-choline PET and CT/MRI showed an accuracy of 66 and 85 %, respectively, while for extrahepatic lesions PET showed an accuracy of 99 %, while the accuracy of CT/MRI was 32 %. In both cases, there was a statistically significant difference in accuracy between the two modalities (p < 0.01). Combination of the PET results with those of CT/MRI resulted in the highest diagnostic accuracy in both analyses, at 92 % for SBA and 96 % for LBA. In 11 patients (24 %) the PET findings modified the therapeutic strategy, the modification proving appropriate in 10 of them.

Conclusion

11C-Choline PET showed good accuracy in investigating patients with HCC and prompted a change in treatment planning in almost one fourth of patients. The main strength of 11C-choline PET/CT resides in its ability to detect extrahepatic HCC localizations, but the combination with conventional imaging modalities allowed for the highest diagnostic accuracy.

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Compliance with ethical standards

All procedures performed in the study were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Conflicts of interest

None.

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Authors and Affiliations

  1. Nuclear Medicine Department, Humanitas Clinical and Research Center, Rozzano, MI, Italy

    Egesta Lopci & Arturo Chiti

  2. Hepatobiliary Surgery, Humanitas Clinical and Research Center, Rozzano, MI, Italy

    Guido Torzilli, Matteo Donadon & Angela Palmisano

  3. Radiology Unit, Humanitas Clinical and Research Center, Rozzano, MI, Italy

    Dario Poretti, Ezio Lanza & Vittorio Pedicini

  4. Medicina Nuclear, Centro Médico Imagem, Sorocaba, Brazil

    Lauro J. Souza de Neto & Juliano Guerra Sabongi

  5. Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center, Rozzano, MI, Italy

    Lorenza Rimassa & Nicola Personeni

  6. Hepatology Unit, Humanitas Clinical and Research Center, Rozzano, MI, Italy

    Roberto Ceriani

  7. Radiosurgery and Radiotherapy, Humanitas Clinical and Research Center, Rozzano, MI, Italy

    Tiziana Comito & Marta Scorsetti

  8. Chair of Diagnostic Imaging, Humanitas University, Rozzano, MI, Italy

    Arturo Chiti

Authors
  1. Egesta Lopci
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  2. Guido Torzilli
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  3. Dario Poretti
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  4. Lauro J. Souza de Neto
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  5. Matteo Donadon
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  6. Lorenza Rimassa
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  7. Ezio Lanza
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  8. Juliano Guerra Sabongi
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  9. Roberto Ceriani
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  10. Nicola Personeni
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  11. Angela Palmisano
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  12. Vittorio Pedicini
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  13. Tiziana Comito
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  14. Marta Scorsetti
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  15. Arturo Chiti
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Corresponding author

Correspondence to Egesta Lopci.

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Lopci, E., Torzilli, G., Poretti, D. et al. Diagnostic accuracy of 11C-choline PET/CT in comparison with CT and/or MRI in patients with hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 42, 1399–1407 (2015). https://doi.org/10.1007/s00259-015-3079-5

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  • DOI: https://doi.org/10.1007/s00259-015-3079-5

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