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Article: 11C-acetate and 18F-FDG PET/CT for clinical staging and selection of patients with hepatocellular carcinoma for liver transplantation on the basis of Milan Criteria: surgeon's perspective

Title11C-acetate and 18F-FDG PET/CT for clinical staging and selection of patients with hepatocellular carcinoma for liver transplantation on the basis of Milan Criteria: surgeon's perspective
Authors
Issue Date2013
Citation
The Journal of Nuclear Medicine, 2013, v. 54 n. 2, p. 192-200 How to Cite?
AbstractThe success of liver transplantation (LT) for hepatocellular carcinoma (HCC) is enhanced by careful patient selection on the basis of the Milan criteria. The criteria are traditionally assessed by contrast CT, which is known to be affected by structural or architectural changes in cirrhotic livers. We aimed to compare dual-tracer (C-11-acetate and F-18-FDG) PET/CT with contrast CT for patient selection on the basis of the Milan criteria. Methods: Patients who had HCC and had undergone both preoperative dual-tracer PET/CT and contrast CT within a 1-mo interval were retrospectively studied. They then underwent either LT (n = 22) or partial hepatectomy (PH) (n = 21; HCC of <= 8 cm). Imaging data were compared with data from postoperative pathologic analysis for accuracy in assessment of parameters specified by the Milan criteria (tumor size and extent, vascular invasion, and metastasis), TNM staging, and patient selection for LT. Results: Dual-tracer PET/CT performed equally well in both LT and PH groups for HCC detection (94.1% vs. 95.8%) and TNM staging (90.9% vs. 90.5%). Contrast CT performed reasonably well in the LT group but not in the PH group for HCC detection (67.6% vs. 37.5%) and TNM staging (54.5% vs. 28.6%). In the LT group, the sensitivity and specificity of contrast CT for patient selection on the basis of the Milan criteria were 43.8% and 66.7%, respectively (comparable to values in the literature); the sensitivity and specificity of dual-tracer PET/CT were 93.8% and 100%, respectively (both Ps < 0.05). From the surgeon's perspective, we tended to perform transplantation for patients with higher diagnostic certainty (stricter CT criteria) because of a shortage of donor grafts. Patients who were not transplant candidates usually underwent up-front hepatectomy without the benefit of reassessment contrast CT, resulting in lower accuracies for the PH group. The overall sensitivity (96.8%) and specificity (91.7%) of dual-tracer PET/CT for patient selection for LT were significantly higher than those of contrast CT (41.9% and 33.0%, respectively) (both Ps < 0.05). Sources of error for contrast CT were related to cirrhosis or previous treatment and included difficulty in differentiating cirrhotic nodules from HCC (39%) and estimation of tumor size (14%). Overstaging of vascular invasion (4.6%) and extrahepatic metastases (4.6%) was infrequent. The rate of false-negative results of dual-tracer PET/CT was 4.7%. Conclusion: Dual-tracer PET/CT was significantly less affected by cirrhotic changes than contrast CT for HCC staging and patient selection for LT on the basis of the Milan criteria. The inclusion of dual-tracer PET/CT in pretransplant workup may warrant serious consideration.
Persistent Identifierhttp://hdl.handle.net/10722/181678
ISSN
2015 Impact Factor: 5.849
2015 SCImago Journal Rankings: 2.541
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorCheung, TTen_US
dc.contributor.authorHo, CLen_US
dc.contributor.authorLo, CMen_US
dc.contributor.authorChen, Sen_US
dc.contributor.authorChan, SCen_US
dc.contributor.authorChok, KSHen_US
dc.contributor.authorFung, JYYen_US
dc.contributor.authorChan, ACYen_US
dc.contributor.authorSharr, WWen_US
dc.contributor.authorYau, TCCen_US
dc.contributor.authorPoon, RTPen_US
dc.contributor.authorFan, STen_US
dc.date.accessioned2013-03-19T03:53:47Z-
dc.date.available2013-03-19T03:53:47Z-
dc.date.issued2013en_US
dc.identifier.citationThe Journal of Nuclear Medicine, 2013, v. 54 n. 2, p. 192-200en_US
dc.identifier.issn0161-5505-
dc.identifier.urihttp://hdl.handle.net/10722/181678-
dc.description.abstractThe success of liver transplantation (LT) for hepatocellular carcinoma (HCC) is enhanced by careful patient selection on the basis of the Milan criteria. The criteria are traditionally assessed by contrast CT, which is known to be affected by structural or architectural changes in cirrhotic livers. We aimed to compare dual-tracer (C-11-acetate and F-18-FDG) PET/CT with contrast CT for patient selection on the basis of the Milan criteria. Methods: Patients who had HCC and had undergone both preoperative dual-tracer PET/CT and contrast CT within a 1-mo interval were retrospectively studied. They then underwent either LT (n = 22) or partial hepatectomy (PH) (n = 21; HCC of <= 8 cm). Imaging data were compared with data from postoperative pathologic analysis for accuracy in assessment of parameters specified by the Milan criteria (tumor size and extent, vascular invasion, and metastasis), TNM staging, and patient selection for LT. Results: Dual-tracer PET/CT performed equally well in both LT and PH groups for HCC detection (94.1% vs. 95.8%) and TNM staging (90.9% vs. 90.5%). Contrast CT performed reasonably well in the LT group but not in the PH group for HCC detection (67.6% vs. 37.5%) and TNM staging (54.5% vs. 28.6%). In the LT group, the sensitivity and specificity of contrast CT for patient selection on the basis of the Milan criteria were 43.8% and 66.7%, respectively (comparable to values in the literature); the sensitivity and specificity of dual-tracer PET/CT were 93.8% and 100%, respectively (both Ps < 0.05). From the surgeon's perspective, we tended to perform transplantation for patients with higher diagnostic certainty (stricter CT criteria) because of a shortage of donor grafts. Patients who were not transplant candidates usually underwent up-front hepatectomy without the benefit of reassessment contrast CT, resulting in lower accuracies for the PH group. The overall sensitivity (96.8%) and specificity (91.7%) of dual-tracer PET/CT for patient selection for LT were significantly higher than those of contrast CT (41.9% and 33.0%, respectively) (both Ps < 0.05). Sources of error for contrast CT were related to cirrhosis or previous treatment and included difficulty in differentiating cirrhotic nodules from HCC (39%) and estimation of tumor size (14%). Overstaging of vascular invasion (4.6%) and extrahepatic metastases (4.6%) was infrequent. The rate of false-negative results of dual-tracer PET/CT was 4.7%. Conclusion: Dual-tracer PET/CT was significantly less affected by cirrhotic changes than contrast CT for HCC staging and patient selection for LT on the basis of the Milan criteria. The inclusion of dual-tracer PET/CT in pretransplant workup may warrant serious consideration.-
dc.languageengen_US
dc.relation.ispartofThe Journal of Nuclear Medicineen_US
dc.title11C-acetate and 18F-FDG PET/CT for clinical staging and selection of patients with hepatocellular carcinoma for liver transplantation on the basis of Milan Criteria: surgeon's perspectiveen_US
dc.typeArticleen_US
dc.identifier.emailCheung, TT: cheung68@hku.hken_US
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_US
dc.identifier.emailChan, SC: chanlsc@hkucc.hku.hken_US
dc.identifier.emailFung, JYY: jfung@hkucc.hku.hken_US
dc.identifier.emailChan, ACY: acchan@hku.hken_US
dc.identifier.emailYau, TCC: tyaucc@hku.hken_US
dc.identifier.emailPoon, RTP: poontp@hku.hken_US
dc.identifier.emailFan, ST: stfan@hku.hken_US
dc.identifier.authorityLo, CM=rp00412en_US
dc.identifier.authorityChan, SC=rp01568en_US
dc.identifier.authorityFung, JYY=rp00518en_US
dc.identifier.authorityChan, ACY=rp00310en_US
dc.identifier.authorityYau, TCC=rp01466en_US
dc.identifier.authorityPoon, RTP=rp00446en_US
dc.identifier.authorityFan, ST=rp00355en_US
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.2967/jnumed.112.107516-
dc.identifier.pmid23321459-
dc.identifier.scopuseid_2-s2.0-84873550587-
dc.identifier.hkuros213638en_US
dc.identifier.volume54en_US
dc.identifier.issue2en_US
dc.identifier.spage192en_US
dc.identifier.epage200en_US
dc.identifier.isiWOS:000314691200018-

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