Diagnostic accuracy of (18) F-methylcholine positron emission tomography/computed tomography for intra- and extrahepatic hepatocellular carcinoma

Hepatology. 2014 Mar;59(3):996-1006. doi: 10.1002/hep.26781. Epub 2014 Jan 30.


Diagnosis of hepatocellular carcinoma (HCC) primarily involves imaging. The aim of this study was to assess the accuracy of (18) F-fluorocholine ((18) F-FCH) positron emission tomography (PET) for detection of HCC and evaluation of extent of disease. Patients with HCC >1 cm were included between 2009 and July 2011, and follow-up closed in February 2013. Diagnosis was based on American Association for the Study of Liver Diseases criteria, and all patients underwent (18) F-FCH PET/computed tomography (CT) at baseline before treatment, 6 underwent a second PET/CT posttreatment, and 1 a third during follow-up. Whole-body PET and low-dose CT imaging were performed 15 minutes after (18) F-FCH injection. Evaluation of imaging was done with standardized uptake value (SUV) ratios: SUV maximum of the lesion divided by the SUV mean of surrounding tissue. Statistical analyses included descriptive analyses, receiver operating characteristic curve, McNemar's test, and Kaplan-Meier's test at 5% level of significance. Twenty-nine patients revealed 53 intrahepatic lesions. In 48 of 53 lesions, (18) F-FCH PET was positive (SUVratio , 1.95 ± 0.66; sensitivity, 88%; specificity, 100%). PET/CT showed uptake in 18 extrahepatic lesions and no uptake in 3 lesions affirmed non-HCC lesions; all lesions were confirmed with additional investigation (accuracy, 100%). In 17 of 29 patients, additional lesions were found on PET/CT imaging, with implications for treatment in 15 patients. Posttreatment PET/CT showed identical results, compared with standard treatment evaluation.

Conclusion: This study shows additional value of (18) F-FCH PET/CT for patients with HCC. (18) F-FCH PET/CT has implications for staging, management, and treatment evaluation because of accurate assessment of extrahepatic disease.

Publication types

  • Clinical Trial
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Ducts, Extrahepatic / diagnostic imaging
  • Bile Ducts, Intrahepatic / diagnostic imaging
  • Carcinoma, Hepatocellular / diagnostic imaging*
  • Choline / analogs & derivatives
  • Female
  • Humans
  • Liver Neoplasms / diagnostic imaging*
  • Male
  • Middle Aged
  • Multimodal Imaging / methods
  • Multimodal Imaging / standards*
  • Positron-Emission Tomography / methods
  • Positron-Emission Tomography / standards
  • Prospective Studies
  • Reproducibility of Results
  • Tomography, X-Ray Computed / methods
  • Tomography, X-Ray Computed / standards
  • Young Adult


  • methylcholine
  • fluorocholine
  • Choline