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.

Original languageEnglish
Pages (from-to)1399-1407
Number of pages9
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume42
Issue number9
DOIs
Publication statusPublished - Aug 24 2015

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Choline
Positron-Emission Tomography
Hepatocellular Carcinoma
Sensitivity and Specificity
Radiopharmaceuticals
Liver
Recurrence
Therapeutics

Keywords

  • <sup>11</sup>C-Choline PET
  • CT
  • Diagnostic accuracy
  • Hepatocellular carcinoma
  • MRI
  • Patient management

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{337e727199154d46b1a4710039aa343d,
title = "Diagnostic accuracy of 11C-choline PET/CT in comparison with CT and/or MRI in patients with hepatocellular carcinoma",
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.",
keywords = "<sup>11</sup>C-Choline PET, CT, Diagnostic accuracy, Hepatocellular carcinoma, MRI, Patient management",
author = "Egesta Lopci and Guido Torzilli and Dario Poretti and {de Neto}, {Lauro J Souza} and Matteo Donadon and Lorenza Rimassa and Ezio Lanza and Sabongi, {Juliano Guerra} and Roberto Ceriani and Nicola Personeni and Angela Palmisano and Vittorio Pedicini and Tiziana Comito and Marta Scorsetti and Arturo Chiti",
year = "2015",
month = "8",
day = "24",
doi = "10.1007/s00259-015-3079-5",
language = "English",
volume = "42",
pages = "1399--1407",
journal = "European Journal of Pediatrics",
issn = "0340-6199",
publisher = "Springer Berlin Heidelberg",
number = "9",

}

TY - JOUR

T1 - Diagnostic accuracy of 11C-choline PET/CT in comparison with CT and/or MRI in patients with hepatocellular carcinoma

AU - Lopci, Egesta

AU - Torzilli, Guido

AU - Poretti, Dario

AU - de Neto, Lauro J Souza

AU - Donadon, Matteo

AU - Rimassa, Lorenza

AU - Lanza, Ezio

AU - Sabongi, Juliano Guerra

AU - Ceriani, Roberto

AU - Personeni, Nicola

AU - Palmisano, Angela

AU - Pedicini, Vittorio

AU - Comito, Tiziana

AU - Scorsetti, Marta

AU - Chiti, Arturo

PY - 2015/8/24

Y1 - 2015/8/24

N2 - 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.

AB - 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.

KW - <sup>11</sup>C-Choline PET

KW - CT

KW - Diagnostic accuracy

KW - Hepatocellular carcinoma

KW - MRI

KW - Patient management

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U2 - 10.1007/s00259-015-3079-5

DO - 10.1007/s00259-015-3079-5

M3 - Article

C2 - 25962590

AN - SCOPUS:84937817415

VL - 42

SP - 1399

EP - 1407

JO - European Journal of Pediatrics

JF - European Journal of Pediatrics

SN - 0340-6199

IS - 9

ER -