Optimal 2-[¹⁸F]fluoro-2-deoxy-d-galactose PET/CT protocol for detection of hepatocellular carcinoma

Positron emission tomography (PET) with the liver-specific galactose tracer 2-[¹⁸F]fluoro-2-deoxy-d-galactose (¹⁸F-FDGal) may improve diagnosis of hepatocellular carcinoma (HCC). The aim of this study was to test which of three different ¹⁸F-FDGal PET protocols gives the highest tumour-to-background (T/B) ratio on PET images and thus better detection of HCC tumours.

Ten patients with a total of 15 hepatic HCC tumours were enrolled prior to treatment. An experienced radiologist defined volumes of interest (VOIs) encircling HCC tumours on contrast-enhanced CT (ce-CT) images. Three PET/CT protocols were conducted following an intravenous ¹⁸F-FDGal injection: (i) a 20-min dynamic PET/CT of the liver (to generate a 3D metabolic image), (ii) a traditional static whole-body PET/CT after 1 h, and (iii) a late static whole-body PET/CT after 2 or 3 h. PET images from each PET/CT protocol were fused with ce-CT images, and the average standardized uptake values (SUV) in tumour and background liver tissue were used to calculate (T/B) ratios. Furthermore, T_peak/B ratios were calculated using the five hottest voxels in all hot tumours. The ratios for the three different PET protocols were compared.

For the individual tumours, there was no significant difference in the T/B ratio between the three PET protocols. The metabolic image yielded higher T_peak/B ratios than the two static images, but it was easier to identify tumours on the static images. One extrahepatic metastasis was detected.

Neither metabolic images nor static whole-body images acquired 2 or 3 h after ¹⁸F-FDGal injection offered an advantage to traditional whole-body PET/CT images acquired after 1 h for detection of HCC.