PERFUSION CT AND PET WITH 18F-FDG AND 18F-FCHO IN THE COMPLEX DIAGNOSIS OF HEPATOCELLULAR CARCINOMA

P. E. Tulin; M. B. Dolgushin; A. A. Odzharova; M. A. Menkov; B. M. Medvedeva; S. V. Shiryaev; Yu. I. Patyutko; B. I. Dolgushin

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PERFUSION CT AND PET WITH 18F-FDG AND 18F-FCHO IN THE COMPLEX DIAGNOSIS OF HEPATOCELLULAR CARCINOMA

P. E. Tulin, M. B. Dolgushin, A. A. Odzharova, M. A. Menkov, B. M. Medvedeva, S. V. Shiryaev, Yu. I. Patyutko, B. I. Dolgushin

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Abstract

Aim. To evaluate possibilities of CT-perfusion and PET methods with ¹⁸F-FDG and ¹⁸F-ftorholin in the complex diagnosis of hepatocellular carcinoma. Materials and Methods. The study included the results of PET/CT with ¹⁸F-FDG, ¹⁸F-ftorholin and CT-perfusion of the liver in 18 patients with histologically confirmed diagnosis of hepatocellular carci noma (HCC). Depending on the degree of tumor differentiation, all patients were divided into 3 groups — patients with highly differentiated (6 patients), moderately differentiated (4 patients), and poorly differentiated HCC (8 patients). PET/CT with ¹⁸F-FDG was performed on an empty stomach with water load 308–501 MBq of ¹⁸F-FDG was administered intravenously for 50–60 minutes before scanning, depending on the patient’s weight. PET/CT with ¹⁸F-ftorholinom was performed 2–3 days after studies with 18F-FDG. The relaxation time was 40 minutes after administration of the radiopharmaceutical. The duration of each PET analysis was 3 minutes per slab. The accumulation levels of the radiopharmaceutical (maxSUV — standardized uptake value) were measured in the solid areas of tumor nodules, in the areas of necrosis (if available) and in the unmodified liver parenchyma. CT-perfusion was performed after the PET/CT in the single scanning with intravenous administration of «Omnipak» 300 mg/ml — 50 ml, the rate of introduction — 2,5–4 ml/s, the time from the introduction of a contrast agent till the scanning — 8 seconds, total scan time — 45 seconds. Data processing was carried out at the Siemens Multy Modality Workplace. Quantitative analysis was performed on the following parameters: BV (blood volume) — ml/100 ml, BF (blood flow) — ml/100 ml/min, ALP (arterial liver perfusion) — ml/100 ml/min, PVP (portal vein liver perfusion) — ml/100 ml/min by measuring the values in the areas of solid tumor nodules, in the areas of necrosis and in the unmodified liver parenchyma. Results. Average values of maxSUV in the group of patients with highly differentiated HCC in PET/CT with ¹⁸F-FDG and ¹⁸F-ftorholin in a solid component of tumor reached 3,51 and 18,24, respectively; in patients with moderately differentiated HCC — 3,91 and 12,32, respectively; in patients with poorly differentiated HCC — 9,58 and 9,70, respectively. Average values of CT perfusion imaging in a solid component of the tumor in the group of patients with highly differentiated HCC were the following: BF — 55,33 ml/100 ml/min, BV — 13,71 ml/100ml, ALP — 52,41 ml/100 ml/min, PVP — 10,81 ml/100 ml/min (p≤0,05), in the group of patients with moderately differentiated HCC: BF — 52,78 ml/100 ml/min, BV — 12,23 ml/100 ml, ALP — 47,26 ml/100 ml/min, PVP — 9,10 ml/100 ml/min (p≤0,05), in the solid component of poorly differentiated HCC: BF — 46,96 ml/100 ml/min, BV — 9,49 ml/100 ml, ALP — 40,54 ml/100 ml/min, PVP — 7,66 ml/100 ml/min (p≤0,05). Conclusions. Integrated use of PET with ¹⁸F-FDG and ¹⁸F-ftorholin and CT-perfusion in the single scanning increases differential diagnostic capabilities PET/CT diagnosis, allows to suggest the degree of HCC differentiation that can be used in treatment planning and predicting the course of disease.