Skip to main content

Advertisement

Log in

Detection rate of radiolabelled choline PET or PET/CT in hepatocellular carcinoma: an updated systematic review and meta-analysis

  • Meta-Analysis
  • Published:
Clinical and Translational Imaging Aims and scope Submit manuscript

Abstract

Background

Different imaging methods have been used to detect hepatocellular carcinoma (HCC). As there are increasing literature data about the role of radiolabelled choline PET/CT in this setting, we aimed to perform an updated meta-analysis about the detection rate (DR) of this imaging method in HCC.

Methods

A comprehensive computer literature search of studies published through December 2018 in PubMed/MEDLINE, Embase and Cochrane library databases regarding the DR of radiolabelled choline PET or PET/CT in patients with HCC was carried out. Pooled DR were calculated on a per patient- and on a per lesion-based analysis. Subgroup analyses taking into account the radiopharmaceutical used were performed.

Results

Nine studies (283 HCC patients) were included in the pooled analysis. The pooled DR of radiolabelled choline PET or PET/CT on a per patient- and on a per lesion-based analysis was 83% [95% confidence interval (95% CI) 75–89%] and 79% (95% CI 72–86%), respectively. A significant heterogeneity among the studies was found on a per lesion-based analysis only. No significant publication bias was found. The subgroup analysis demonstrated a trend towards a higher DR when using 18F-choline compared to 11C-choline, without a statistically significant difference. Pooled DR of HCC using dual-tracer PET/CT (radiolabelled choline and 18F-FDG) on a per patient- and a per lesion-based analysis was 91% (95% CI 87–95%) and 89% (95% CI 80–95%), respectively, without significant heterogeneity.

Conclusions

Radiolabelled choline PET/CT demonstrated good ability in detecting HCC. The DR increased when dual-tracer PET/CT was performed. Large multicenter studies and cost-effectiveness analyses are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kulik L, El-Serag HB (2019) Epidemiology and management of hepatocellular carcinoma. Gastroenterology 156(2):477–491

    Article  PubMed  Google Scholar 

  2. Lange N, Dufour JF (2019) Changing epidemiology of HCC: how to screen and identify patients at risk? Dig Dis Sci. https://doi.org/10.1007/s10620-019-05515-8

    Article  PubMed  Google Scholar 

  3. Ronot M, Purcell Y, Vilgrain V (2019) Hepatocellular carcinoma: current imaging modalities for diagnosis and prognosis. Dig Dis Sci 1:1. https://doi.org/10.1007/s10620-019-05547-0

    Article  CAS  Google Scholar 

  4. Kornberg A, Friess H (2019) (18)F-fludeoxyglucose positron emission tomography for diagnosis of HCC: implications for therapeutic strategy in curative and non-curative approaches. Therap Adv Gastroenterol. 19(12):1756284819836205. https://doi.org/10.1177/1756284819836205

    Article  Google Scholar 

  5. Treglia G, Sadeghi R, Del Sole A, Giovanella L (2014) Diagnostic performance of PET/CT with tracers other than F-18-FDG in oncology: an evidence-based review. Clin Transl Oncol 16(9):770–775

    Article  CAS  PubMed  Google Scholar 

  6. Haug AR (2017) Imaging of primary liver tumors with positron-emission tomography. Q J Nucl Med Mol Imaging. 61(3):292–300

    PubMed  Google Scholar 

  7. Treglia G, Giovannini E, Di Franco D, Calcagni ML, Rufini V, Picchio M, Giordano A (2012) The role of positron emission tomography using carbon-11 and fluorine-18 choline in tumors other than prostate cancer: a systematic review. Ann Nucl Med 26(6):451–461

    Article  CAS  PubMed  Google Scholar 

  8. Bertagna F, Bertoli M, Bosio G, Biasiotto G, Sadeghi R, Giubbini R, Treglia G (2014) Diagnostic role of radiolabelled choline PET or PET/CT in hepatocellular carcinoma: a systematic review and meta-analysis. Hepatol Int 8(4):493–500

    Article  PubMed  Google Scholar 

  9. Treglia G, Piccardo A, Imperiale A, Strobel K, Kaufmann PA, Prior JO, Giovanella L (2019) Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 46(3):751–765

    Article  CAS  PubMed  Google Scholar 

  10. Treglia G, Ceriani L, Sadeghi R, Giovacchini G, Giovanella L (2014) Relationship between prostate-specific antigen kinetics and detection rate of radiolabelled choline PET/CT in restaging prostate cancer patients: a meta-analysis. Clin Chem Lab Med 52(5):725–733

    Article  CAS  PubMed  Google Scholar 

  11. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, The PRISMA-DTA Group, Clifford T, Cohen JF, Deeks JJ, Gatsonis C, Hooft L, Hunt HA, Hyde CJ, Korevaar DA, Leeflang MMG, Macaskill P, Reitsma JB, Rodin R, Rutjes AWS, Salameh JP, Stevens A, Takwoingi Y, Tonelli M, Weeks L, Whiting P, Willis BH (2018) Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA 319(4):388–396

    Article  PubMed  Google Scholar 

  12. Simera I, Moher D, Hoey J, Schulz KF, Altman DG (2010) A catalogue of reporting guidelines for health research. Eur J Clin Invest 40:35–53

    Article  CAS  PubMed  Google Scholar 

  13. Sadeghi R, Treglia G (2017) Systematic reviews and meta-analyses of diagnostic studies: a practical guideline. Clin Transl Imaging 5:83–87

    Article  Google Scholar 

  14. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM, QUADAS-2 Group (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536

    Article  Google Scholar 

  15. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  Google Scholar 

  16. Harbord RM, Egger M, Sterne JA (2006) A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 25:3443–3457

    Article  PubMed  Google Scholar 

  17. Chalaye J, Costentin CE, Luciani A, Amaddeo G, Ganne-Carrié N, Baranes L, Allaire M, Calderaro J, Azoulay D, Nahon P, Seror O, Mallat A, Soussan M, Duvoux C, Itti E, Nault JC (2018) Positron emission tomography/computed tomography with 18F-fluorocholine improve tumor staging and treatment allocation in patients with hepatocellular carcinoma. J Hepatol 69(2):336–344

    Article  PubMed  Google Scholar 

  18. Tulin PE, Dolgushin MB, Odzharova AA, Mikhaylov AI, Medvedeva BM, Shiryaev SV, Dolgushin BI (2017) Perfusion CT and PET with 18F-FDG and 18F-FCh in the complex diagnosis of hepatocellular carcinoma. Eur J Hybrid Imaging 1(1):13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kwee SA, Sato MM, Kuang Y, Franke A, Custer L, Miyazaki K, Wong LL (2017) [(18)F]Fluorocholine PET/CT imaging of liver cancer: radiopathologic correlation with tissue phospholipid profiling. Mol Imaging Biol 19(3):446–455

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kwee SA, Okimoto GS, Chan OT, Tiirikainen M, Wong LL (2016) Metabolic characteristics distinguishing intrahepatic cholangiocarcinoma: a negative pilot study of (18)F-fluorocholine PET/CT clarified by transcriptomic analysis. Am J Nucl Med Mol Imaging 6(1):73–83

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Castilla-Lièvre MA, Franco D, Gervais P, Kuhnast B, Agostini H, Marthey L, Désarnaud S, Helal BO (2016) Diagnostic value of combining 11C-choline and 18F-FDG PET/CT in hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 43(5):852–859

    Article  CAS  PubMed  Google Scholar 

  22. Chotipanich C, Kunawudhi A, Promteangtrong C, Tungsuppawattanakit P, Sricharunrat T, Wongsa P (2016) Diagnosis of hepatocellular carcinoma Using C11 Choline PET/CT: comparison with F18 FDG, contrast enhanced MRI and MDCT. Asian Pac J Cancer Prev 17(7):3569–3573

    PubMed  Google Scholar 

  23. Kwee SA, Wong LL, Hernandez BY, Chan OT, Sato MM, Tsai N (2015) Chronic liver disease and the detection of hepatocellular carcinoma by [(18)F]fluorocholine PET/CT. Diagnostics (Basel) 5(2):189–199

    Article  CAS  Google Scholar 

  24. Lopci E, Torzilli G, Poretti D, de Neto LJ, Donadon M, Rimassa L, Lanza E, Sabongi JG, Ceriani R, Personeni N, Palmisano A, Pedicini V, Comito T, Scorsetti M, Chiti A (2015) 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(9):1399–1407

    Article  CAS  PubMed  Google Scholar 

  25. Bieze M, Klümpen HJ, Verheij J, Beuers U, Phoa SS, van Gulik TM, Bennink RJ (2014) Diagnostic accuracy of (18) F-methylcholine positron emission tomography/computed tomography for intra- and extrahepatic hepatocellular carcinoma. Hepatology 59(3):996–1006

    Article  CAS  PubMed  Google Scholar 

  26. Fartoux L, Balogova S, Nataf V, Kerrou K, Huchet V, Rosmorduc O, Talbot JN (2012) A pilot comparison of 18F-fluorodeoxyglucose and 18F-fluorocholine PET/CT to predict early recurrence of unifocal hepatocellular carcinoma after surgical resection. Nucl Med Commun 33(7):757–765

    Article  PubMed  Google Scholar 

  27. Wu HB, Wang QS, Li BY, Li HS, Zhou WL, Wang QY (2011) F-18 FDG in conjunction with 11C-choline PET/CT in the diagnosis of hepatocellular carcinoma. Clin Nucl Med 36(12):1092–1097

    Article  PubMed  Google Scholar 

  28. Talbot JN, Fartoux L, Balogova S, Nataf V, Kerrou K, Gutman F, Huchet V, Ancel D, Grange JD, Rosmorduc O (2010) Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med 51(11):1699–1706

    Article  PubMed  Google Scholar 

  29. Yamamoto Y, Nishiyama Y, Kameyama R, Okano K, Kashiwagi H, Deguchi A, Kaji M, Ohkawa M (2008) Detection of hepatocellular carcinoma using 11C-choline PET: comparison with 18F-FDG PET. J Nucl Med 49(8):1245–1248

    Article  PubMed  Google Scholar 

  30. Talbot JN, Gutman F, Fartoux L, Grange JD, Ganne N, Kerrou K, Grahek D, Montravers F, Poupon R, Rosmorduc O (2006) PET/CT in patients with hepatocellular carcinoma using [(18)F]fluorocholine: preliminary comparison with [(18)F]FDG PET/CT. Eur J Nucl Med Mol Imaging 33(11):1285–1289

    Article  PubMed  Google Scholar 

  31. Lanza E, Donadon M, Felisaz P, Mimmo A, Chiti A, Torzilli G, Balzarini L, Lopci E (2017) Refining the management of patients with hepatocellular carcinoma integrating 11C-choline PET/CT scan into the multidisciplinary team discussion. Nucl Med Commun 38(10):826–836

    Article  PubMed  Google Scholar 

  32. Kolthammer JA, Corn DJ, Tenley N, Wu C, Tian H, Wang Y, Lee Z (2011) PET imaging of hepatocellular carcinoma with 18F-fluoroethylcholine and 11C-choline. Eur J Nucl Med Mol Imaging 38(7):1248–1256

    Article  CAS  PubMed  Google Scholar 

  33. Fraum TJ, Ludwig DR, Hope TA, Fowler KJ (2018) PET/MRI for gastrointestinal imaging: current clinical status and future prospects. Gastroenterol Clin N Am 47(3):691–714

    Article  Google Scholar 

Download references

Funding

The authors declare that they have no financial or non-financial competing interests.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giorgio Treglia.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest relevant to this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Signore, G., Nicod-Lalonde, M., Prior, J.O. et al. Detection rate of radiolabelled choline PET or PET/CT in hepatocellular carcinoma: an updated systematic review and meta-analysis. Clin Transl Imaging 7, 237–253 (2019). https://doi.org/10.1007/s40336-019-00332-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40336-019-00332-5

Keywords

Navigation