¹⁸F-FDG PET in the detection of extrahepatic metastases from hepatocellular carcinoma

Abstract

Background

Positron emission tomography (PET) with ¹⁸F-fluoro-2-deoxy-d-glucose (¹⁸F-FDG) is useful in detecting distant metastases from a variety of malignancies. However, its efficiency in detecting distant metastases from hepatocellular carcinoma (HCC) has not been investigated. The aim of this study was to evaluate the usefulness of ¹⁸F-FDG PET for the detection of extrahepatic metastases from HCC.

Methods

Nineteen patients suspected of having extrahepatic HCC underwent ¹⁸F-FDG PET. Fourteen patients (group A) had extrahepatic lesions, which were detected by conventional studies. In five patients (group B), conventional imaging showed no extra- or intrahepatic lesions, but the tumor marker levels were elevated. The PET results were compared with those obtained by histopathology or by clinical follow-up.

Results

The detection rate of ¹⁸F-FDG PET was 83% (24 of 29 metastases) for extrahepatic metastases larger than 1 cm in greatest diameter and 13% (1 of 8 metastases) for lesions less than or equal to 1 cm. PET revealed two bone metastases not depicted by bone scan, and detected the nodal metastasis and intestinal metastases inconclusive on computed tomography. Extrahepatic lesions were resected in 5 patients of group A on the basis of PET findings. In all patients of group B, PET results were true negative for extrahepatic metastases, but HCCs were detected in the liver within 4 months in 4 patients. These were no false-positive lesions in either group.

Conclusions

This preliminary study suggested that ¹⁸F-FDG PET could provide additional information and contribute to the management of HCC patients suspected of having extrahepatic metastases.