Journal Article

A dual-tracer approach using 11CCH and 18FFDG in HCC clinical decision making

Dierckx, Rudi A. J. O, Veenstra, Emile B, de Jong, Koert P, Noordzij, Walter, Erba, Paola A, Ruiter, Simeon J. S, de Haas, Robbert J

2023

Overview

BackgroundEarly detection of recurrent or progressive HCC remains the strongest prognostic factor for survival. Dual tracer PET/CT imaging with [11C]CH and [18F]FDG can further increase detection rates as both tracers entail different metabolic pathways involved in HCC development. We investigated dual-tracer PET/CT in clinical decision making in patients suspected of recurrent or progressive HCC. All HCC patients who underwent both [11C]CH and [18F]FDG PET/CT in our institute from February 2018 to December 2021 were included. Both tracer PET/CT were within 4 weeks of each other with at least 6-month follow-up. Patients underwent dual tracer PET/CT because of unexplained and suspicious CT/MRI or sudden rise of serum tumour markers. A detected lesion was considered critical when the finding had prognostic consequences leading to treatment changes.ResultsNineteen patients who underwent [11C]CH and [18F]FDG PET/CT were included of which all but six patients were previously treated for HCC. Dual-tracer critical finding detection rate was 95%, with [18F]FDG 68%, and [11C]CH 84%. Intrahepatic HCC recurrence finding rate was 65% for both tracers. [18F]FDG found more ablation site recurrences (4/5) compared to [11C]CH (2/5). Only [11C]CH found two needle tract metastases. Both tracers found 75% of the positive lymph nodes. Two new primary tumours were found, one by [18F]FDG and both by [11C]CH.ConclusionsOur study favours a dual-tracer approach in HCC staging in high-risk patients or when conventional imaging is non-conclusive.

• Publisher: Springer Nature B.V
• Subject: Ablation / Clinical decision making / Computed tomography / Decision making / Fluorine isotopes / Liver cancer / Medical imaging / Positron emission / Tracers / Tumors