Purpose: F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET)/computed tomography (CT) alone has limited sensitivity for the diagnosis of hepatocellular carcinoma (HCC). We hoped to improve the diagnostic sensitivity by combining F-18 FDG and C-choline PET/CT.
Materials and methods: A total of 76 consecutive patients with HCC were prospectively enrolled. Whole-body F-18 FDG PET/CT scan was performed for all patients. In those patients with negative F-18 FDG scans, a regional C-choline PET/CT scan was also performed.
Results: Positive F-18 FDG scans were noted in 61.1% (48/76) patients with HCC. Increased F-18 FDG uptake correlated with decreased tumor differentiation (P = 0.042). In 28 HCC patients with negative F-18 FDG scans, C-choline scan was positive in 71.4% patients. C-choline scan did not detect any significant difference between well- and moderately differentiated HCC (P = 0.585). Compared with F-18 FDG scan, C-choline scan showed a trend toward an improved detection of well-differentiated HCC (66.7% vs. 35.7%, NS). For detection of moderately differentiated HCC, the sensitivity of C-choline and F-18 FDG PET/CT was similar (85.7% vs. 72.0%, P = 0.648). The dual-tracer modality improved the diagnostic sensitivity of F-18 FDG PET/CT alone from 63.1% to 89.5% (P < 0.001).
Conclusions: F-18 FDG in conjunction with C-choline increases the sensitivity of PET/CT in detecting HCC.