n-n-dimethyl-n-(18f)fluoromethyl-2-hydroxyethylammonium and Liver-Neoplasms

Diagnosis of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) using conventional imaging techniques can be difficult; however, it is important to differentiate between them as these benign liver tumors require different therapeutic strategies. The aim of our study was to prospectively evaluate the use of PET/computed tomography (CT) with F-fluoromethylcholine (F-FCH) as a novel diagnostic approach in the differentiation between HCA and FNH.. Fifty-six consecutive patients with a suspicion of one or multiple HCAs or FNHs larger than 2 cm were prospectively included after written informed consent was obtained from them. All the patients underwent a PET/CT with F-FCH. Histopathology of the lesions was the standard of reference. The ratio of the standardized uptake value (SUV) of the lesions compared with normal liver uptake within the same patient was calculated. Statistical tests were evaluated at the 95% confidence interval.. Forty-nine patients with 60 lesions and histopathological diagnosis of FNH or HCA completed the study and were analyzed. The mean SUV ratio for FNH was 1.67±0.31 (mean±SD, n=28), resulting in a positive likelihood ratio of 32.3 for PET-positive FNH. The mean SUV ratio for HCA was 0.82±0.17 (n=32), with a likelihood ratio of ∼100 for PET-negative HCA. Receiver operating characteristic curve analysis revealed an optimal SUV ratio cutoff value of 1.13, which reached 100% sensitivity and 97% specificity in differentiating FNH from HCA.. This prospective study shows that PET/CT with F-FCH can accurately differentiate FNH from HCA and may become a valuable diagnostic tool when conventional imaging techniques fail to do so.

Topics: Adenoma, Liver Cell; Adult; Aged; Choline; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Humans; Liver Neoplasms; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Young Adult

The role of positron emission tomography/computed tomography (PET/CT) in hepatocellular carcinoma (HCC) management is not clearly defined. Our objective was to analyze the utility of dual-PET/CT (. Between January 2011 and April 2019, 168 consecutive HCC patients with available baseline dual-PET/CT imaging data were retrospectively analyzed. To identify potential refinement criteria for surgically-treated patients, survival Kaplan-Meier curves of various standard-of-care and dual-PET/CT baseline parameters were estimated. Finally, multivariate cox proportional hazard ratios of the most relevant clinico-biological and/or PET parameters were estimated.

Topics: alpha-Fetoproteins; Carcinoma, Hepatocellular; Choline; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Retrospective Studies

In a 54-year-old patient referred for 18F-fluorocholine (FCH) baseline PET/CT before chemotherapy for biopsy-proven liver metastases, FCH PET/CT demonstrated multiple hypodense hepatic lesions with no FCH uptake and 2 positive bone metastases. FCH PET/CT performed after 6 cycles of docetaxel demonstrated a near normalization of the physiological uptake in the area of the sterilized liver metastases, which was confirmed by a drop in prostate-specific antigen and a complete metabolic response in the bone metastases. The present case demonstrates a new pattern of response defined by a reverse phenomenon from photopenic to normal uptake in responding liver metastases.

Topics: Bone Neoplasms; Choline; Humans; Liver Neoplasms; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

Transarterial radioembolization (TARE) is widely used for the treatment of hepatocellular carcinoma (HCC), but early treatment response can be very difficult to assess. The aim was to evaluate 18F-fluorocholine PET/computed tomography (CT) to assess the treatment response in patients with intermediate or locally advanced HCC.. Between March 2019 and July 2020, nine HCC patients treated with TARE, who underwent PET/CT at baseline and 1 month after treatment, were enrolled. The maximum, mean (SUVmean), and peak (SUVpeak) standardized uptake value (SUV), SUV normalized by lean body mass (SUL), and total lesion glycolysis (TLG) were measured. Statistical analysis used the Mann-Whitney test to evaluate the differences in parameters between responders (partial and complete response) and nonresponders (stable or progressive disease) at the 6-month follow-up, according to the modified Response Evaluation Criteria in Solid Tumors.. Three patients were nonresponders (progressive disease and stable disease) and six were responders. Delta SUVmean, delta SUL, and delta TLG could predict an early response (P = 0.02, P = 0.04, and P = 0.02, respectively). None of the pre-therapeutic parameters were correlated with the response. Post-therapeutic SUL, SUVmean, TLG, and SUVpeak were also predictive of the response.. Our preliminary results showed that changes in certain metabolic parameters (from baseline PET to 1-month PET) are predictive of the response to TARE in HCC (Delta SUVmean, delta TLG, and delta SUL). The absence of post-treatment inflammation could lead to a better prediction than MRI evaluation. This study suggests that 1-month 18F-choline PET/CT could modify the clinical management predicting responders.Video Abstract: http://links.lww.com/NMC/A193.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Choline; Embolization, Therapeutic; Glycolysis; Humans; Liver Neoplasms; Male; Middle Aged; Positron Emission Tomography Computed Tomography

We present a case of a 68-year-old woman undergoing 18F-choline PET/CT due to a history of hepatocellular cancer treated with multimodal therapies and with a rapid increase in α-fetoprotein. 18F-Choline PET/CT showed multiple uptakes in the skeletal muscles compatible with the recurrence of disease. The interpretation of 18F-choline PET/CT in this cancer should be careful and discussed in a multidisciplinary team.

Topics: Aged; Carcinoma, Hepatocellular; Choline; Humans; Liver Neoplasms; Male; Muscle, Skeletal; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals

To compare the performance of the quantitative analysis of the hepatobiliary phase (HBP) tumor enhancement in gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI and of dual-tracer 18F-FDG and 18F-fluorocholine (FCH) PET/CT for the prediction of tumor aggressiveness and recurrence-free survival (RFS) in resectable hepatocellular carcinoma (HCC).. This retrospective, IRB approved study included 32 patients with 35 surgically proven HCCs. All patients underwent Gd-BOPTA-enhanced MRI including delayed HBP images, 18F-FDG PET/CT, and (for 29/32 patients) 18F-FCH PET/CT during the 2 months prior to surgery. For each lesion, the lesion-to-liver contrast enhancement ratio (LLCER) on MRI HBP images and the SUV. HBP tumor enhancement after Gd-BOPTA injection may help identify aggressive HCC pathological features, and patients with reduced recurrence-free survival after surgical resection.. • In patients with resectable HCC, the quantitative analysis of the HBP tumor enhancement in Gd-BOPTA-enhanced MRI (LLCER) accurately identifies moderately-poorly differentiated and/or MVI-positive HCCs. • After surgical resection for HCC, patients with LLCER - 4.72% or less had significantly poorer recurrence-free survival than patients with LLCER superior to - 4.72%. • Gd-BOPTA-enhanced MRI with delayed HBP images may be suggested as part of pre-surgery workup in patients with resectable HCC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Choline; Contrast Media; Disease-Free Survival; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Neoplasm Staging; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Recurrence; Retrospective Studies

We report the case of a 69-year-old man referred for F-fluorocholine (FCH) PET/CT for a biochemical recurrence of prostate cancer. FCH PET/CT demonstrated 2 hypodense hepatic lesions with no uptake but progressing in size compared with a previous assessment. MRI showed a suspicious peripheral contrast enhancement, raising the question of a liver metastasis. Histopathologic examination concluded to a prostate adenocarcinoma metastasis. This case highlights an unusual pitfall in FCH PET/CT: the lack of uptake in prostatic liver metastasis is presumably due to the partial volume effect induced by the necrotic center and the high uptake of the liver.

Topics: Adenocarcinoma; Aged; Biological Transport; Choline; Humans; Liver Neoplasms; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

Positron emission tomography (PET) using the cationic compound [

Topics: Adenoma, Liver Cell; Carcinoma, Hepatocellular; Choline; Diagnosis, Differential; Female; Fluorine Radioisotopes; HEK293 Cells; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Organic Cation Transport Proteins; Organic Cation Transporter 1; Positron-Emission Tomography; Tissue Distribution

Diagnosis of recurrent hepatocellular carcinoma (HCC) is sometimes challenging, especially when extrahepatic disease is present. Here, we report on a 49-year-old woman with a history of HCC who was referred to our institution with suspicion of tumor recurrence for further workup. Combined F-choline PET/CT revealed a soft tissue mass at the right thoracic wall highly consistent with HCC.

Topics: alpha-Fetoproteins; Carcinoma, Hepatocellular; Choline; Female; Fluorine Radioisotopes; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Soft Tissue Neoplasms; Thoracic Wall; Tomography, X-Ray Computed

Hepatoblastoma is a rare carcinoma mostly seen in children. Neoadjuvant chemotherapy followed by resection and adjuvant chemotherapy is the optimal treatment. We present the case of an 18-year-old woman who presented with abdominal pain, nausea, bloating, and fatigue. MRI showed 3 hepatic lesions with high signal intensity on arterial phase T1-weighted images and slight washout on the late phase, suggestive for hepatocellular carcinoma. Laboratory examinations revealed plasma α-feto-protein of 114,245 μg/L. Subsequent baseline and posttreatment F-fluoromethyl choline PET/CT were performed to possibly evaluate extent of the disease and assess disease response after neoadjuvant chemotherapy.

Topics: Adolescent; Choline; Female; Hepatoblastoma; Humans; Liver Neoplasms; Multimodal Imaging; Positron-Emission Tomography; Tomography, X-Ray Computed

F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has variable efficacy in evaluating hepatocellular carcinoma. We present a case of a new oncologic imaging tracer fluoromethylcholine (FCH), which has visualized recurrent multifocal hepatoma in a patient with a poor FDG avid hepatic tumour. The lesions demonstrated on FCH PET correlated well with the findings on CT hepatic angiography.

Topics: Carcinoma, Hepatocellular; Choline; Female; Humans; Image Enhancement; Liver Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Positron-Emission Tomography; Radiopharmaceuticals