Evaluation of patients with hepatocellular carcinomas using [11C]acetate and [18F]FDG PET/CT: A preliminary study

It is well known that [F-18]FDG PET has a low sensitivity in the detection of hepatocellular carcinoma (HCC). We prospectively compared [C-11]acetate PET/CT results with those of [F-18]FDG PET/CT in patients with HCCs. Thirteen patients (M:F = 11:2, mean age of 51 +/- 12) with suspicious or confirmed HCCs underwent [C-11]acetate PET/CT with or without [F-18]FDC; PET/CT (both [C-11]acetate and [F-18]FDG PET/CT were performed in 10 patients). HCC was confirmed by histopathology or clinical criteria in 12 patients and one benign liver lesion. Both PET/CT images were interpreted by two experienced nuclear physicians, supported by standardized uptake value (SUV). A total of 12 patients were confirmed to have initial or recurrent HCCs. [F-18]FDG PET/CT showed markedly increased uptake in only two patients, moderately increased uptake in another two and negative in six. [C-11]acetate PET/CT demonstrated markedly increased uptake in seven patients, moderately increased uptake in three and negative in only two. One HCC metastatic lesion was detected only by [C-11]acetate PET/CT. For detection of HCC, [C-11]acetate PET/CT showed a high sensitivity of 83%, whereas [F-18]FDG PET/CT only of 40%. The study results demonstrated that [F-18]FDG PET/CT has a limitation in detection of HCC and [C-11]acetate PET/CT has a complementary role to [F-18]FDG PET/CT. When primary HCC showed low [F-18]FDG uptake, it was [C-11]acetate-avid, and vice versa. It may be useful to combine both [F-18]FDG and [C-11]acetate PET/CT for detection of HCCs. (C) 2009 Elsevier Ltd. All rights reserved.