Molecular Imaging in Hepatocellular Carcinoma
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P: 170-180
July 2024

Molecular Imaging in Hepatocellular Carcinoma

Nucl Med Semin 2024;10(2):170-180
No information available.
No information available
Online Date: 31.07.2024
Publish Date: 31.07.2024
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Abstract

Hepatocellular carcinomas (HCCs) are clinically and pathologically heterogeneous tumors that exhibit resistance to chemotherapy and have aggressive characteristics. The most commonly used positron emission tomography (PET) radiopharmaceutical, Fluorine-18 (F-18) fluorodeoxyglucose (FDG), has been disappointing in the evaluation of HCC. This disappointment has led to studies using various radiopharmaceuticals such as choline derivatives, acetate, and prostate-specific membrane antigen, which complement and/or enhance the role of FDG. This article aims to examine the various PET radiopharmaceuticals used for HCC imaging and the specific pathways these agents target in HCC and liver cancers.

Keywords:
Hepatocellular carcinoma, positron emission tomography, PSMA, choline, FDG, FAPI

References

1
Zhu AX, Duda DG, Sahani DV, Jain RK. HCC and angiogenesis: possible targets and future directions. Nat Rev Clin Oncol. 2011;8:292-301.
2
McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of Hepatocellular Carcinoma. Hepatology. 2021;73(Suppl 1):4-13.
3
Lu RC, She B, Gao WT, et al. Positron-emission tomography for hepatocellular carcinoma: Current status and future prospects. World J Gastroenterol. 2019;25:4682-4695.
4
McGlynn KA, Petrick JL, London WT. Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability. Clin Liver Dis. 2015;19:223-238.
5
Ho CL, Yu SC, Yeung DW. 11C-acetate PET imaging in hepatocellular carcinoma and other liver masses. J Nucl Med. 2003;44:213-221.
6
Addissie BD, Roberts LR. Classification and staging of hepatocellular carcinoma: an aid to clinical decision-making. Clin Liver Dis. 2015;19:277-294.
7
Khan MA, Combs CS, Brunt EM, et al. Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol. 2000;32:792-797.
8
Bruix J, Reig M, Sherman M. Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology. 2016;150:835-853.
9
Hirmas N, Leyh C, Sraieb M, et al. 68Ga-PSMA-11 PET/CT Improves Tumor Detection and Impacts Management in Patients with Hepatocellular Carcinoma. J Nucl Med. 2021;62:1235-1241.
10
Koulouris A, Tsagkaris C, Spyrou V, Pappa E, Troullinou A, Nikolaou M. Hepatocellular Carcinoma: An Overview of the Changing Landscape of Treatment Options. J Hepatocell Carcinoma. 2021;8:387-401.
11
Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology. 2014;272:635-654.
12
European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908-943.
13
Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016. Clin Mol Hepatol. 2016;22:7-17.
14
Simpson HN, McGuire BM. Screening and detection of hepatocellular carcinoma. Clin Liver Dis. 2015;19:295-307.
15
Chen J, Zhu J, Zhang C, Song Y, Huang P. Contrast-enhanced ultrasound for the characterization of portal vein thrombosis vs tumor-in-vein in HCC patients: a systematic review and meta-analysis. Eur Radiol. 2020;30:2871-2880.
16
Anis M. Imaging of hepatocellular carcinoma: new approaches to diagnosis. Clin Liver Dis. 2015;19:325-340.
17
Lee YJ, Lee JM, Lee JS, et al. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis. Radiology. 2015;275:97-109.
18
Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67:358-380.
19
Chernyak V, Fowler KJ, Kamaya A, et al. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients. Radiology. 2018;289:816-830.
20
Czernin J, Allen-Auerbach M, Nathanson D, Herrmann K. PET/CT in Oncology: Current Status and Perspectives. Curr Radiol Rep. 2013;1:177-190.
21
Beyer T, Townsend DW, Brun T, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med. 2000;41:1369-1379.
22
Izuishi K, Yamamoto Y, Mori H, et al. Molecular mechanisms of [18F]fluorodeoxyglucose accumulation in liver cancer. Oncol Rep. 2014;31:701-706.
23
Lundholm K, Edström S, Karlberg I, Ekman L, Scherstén T. Glucose turnover, gluconeogenesis from glycerol, and estimation of net glucose cycling in cancer patients. Cancer. 1982;50:1142-1150.
24
Sacks A, Peller PJ, Surasi DS, Chatburn L, Mercier G, Subramaniam RM. Value of PET/CT in the management of primary hepatobiliary tumors, part 2. AJR Am J Roentgenol. 2011;197:W260-W265.
25
Cho KJ, Choi NK, Shin MH, Chong AR. Clinical usefulness of FDG-PET in patients with hepatocellular carcinoma undergoing surgical resection. Ann Hepatobiliary Pancreat Surg. 2017;21:194-198.
26
Torizuka T, Tamaki N, Inokuma T, et al. In vivo assessment of glucose metabolism in hepatocellular carcinoma with FDG-PET. J Nucl Med. 1995;36:1811-1817.
27
Wolfort RM, Papillion PW, Turnage RH, Lillien DL, Ramaswamy MR, Zibari GB. Role of FDG-PET in the evaluation and staging of hepatocellular carcinoma with comparison of tumor size, AFP level, and histologic grade. Int Surg. 2010;95:67-75.
28
Talbot JN, Fartoux L, Balogova S, et al. Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med. 2010;51:1699-1706.
29
Sacks A, Peller PJ, Surasi DS, Chatburn L, Mercier G, Subramaniam RM. Value of PET/CT in the management of liver metastases, part 1. AJR Am J Roentgenol 2011;197:W256-W259.
30
Delbeke D, Martin WH, Sandler MP, Chapman WC, Wright JK Jr, Pinson CW. Evaluation of benign vs malignant hepatic lesions with positron emission tomography. Arch Surg. 1998;133:510-515; discussion 515-516.
31
Kubota R, Kubota K, Yamada S, Tada M, Ido T, Tamahashi N. Active and passive mechanisms of [fluorine-18] fluorodeoxyglucose uptake by proliferating and prenecrotic cancer cells in vivo: a microautoradiographic study. J Nucl Med. 1994;35:1067-1075.
32
Shiomi S, Nishiguchi S, Ishizu H, et al. Usefulness of positron emission tomography with fluorine-18-fluorodeoxyglucose for predicting outcome in patients with hepatocellular carcinoma. Am J Gastroenterol. 2001;96:1877-1880.
33
Kawaoka T, Aikata H, Takaki S, et al. FDG positron emission tomography/computed tomography for the detection of extrahepatic metastases from hepatocellular carcinoma. Hepatol Res. 2009;39:134-142.
34
Wudel LJ Jr, Delbeke D, Morris D, et al. The role of [18F]fluorodeoxyglucose positron emission tomography imaging in the evaluation of hepatocellular carcinoma. Am Surg. 2003;69:117-124; discussion 124-126.
35
Afshar-Oromieh A, Avtzi E, Giesel FL, et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med. Mol Imaging 2015;42:197-209.
36
Perera M, Papa N, Christidis D, et al. Sensitivity, Specificity, and Predictors of Positive 68Ga-Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. 2016;70:926-937.
37
Kornberg A, Witt U, Schernhammer M, et al. Combining 18F-FDG positron emission tomography with Up-to-seven criteria for selecting suitable liver transplant patients with advanced hepatocellular carcinoma. Sci Rep. 2017;7:14176.
38
Sergeeva O, Zhang Y, Julian W, et al. Imaging of Tumor-Associated Vascular Prostate-Specific Membrane Antigen in Woodchuck Model of Hepatocellular Carcinoma. Gastro Hep Adv. 2022;1:631-639.
39
Donin NM, Reiter RE. Why Targeting PSMA Is a Game Changer in the Management of Prostate Cancer. J Nucl Med. 2018;59:177-182.
40
Sasikumar A, Joy A, Nanabala R, Pillai MR, Thomas B, Vikraman KR. (68)Ga-PSMA PET/CT imaging in primary hepatocellular carcinoma. Eur J Nucl Med Mol Imaging. 2016;43:795-796.
41
Kesler M, Levine C, Hershkovitz D, et al. 68Ga-PSMA is a novel PET-CT tracer for imaging of hepatocellular carcinoma: A prospective pilot study. J Nucl Med. 2019;60:185-191.
42
Denmeade SR, Mhaka AM, Rosen DM, et al. Engineering a prostate-specific membrane antigen-activated tumor endothelial cell prodrug for cancer therapy. Sci Transl Med. 2012;4:140ra86.
43
Gündoğan C, Ergül N, Çakır MS, et al. 68Ga-PSMA PET/CT Versus 18F-FDG PET/CT for Imaging of Hepatocellular Carcinoma. Mol Imaging Radionucl Ther. 2021;30:79-85.
44
Grant CL, Caromile LA, Ho V, et al. Prostate specific membrane antigen (PSMA) regulates angiogenesis independently of VEGF during ocular neovascularization. PLoS One. 2012;7:e41285.
45
Sergeeva O, Zhang Y, Sergeev M, et al. Characterization of tumor-associated neovasculature in HCC. J Nucl Med. 2018;59:1274.
46
Yamamoto Y, Nishiyama Y, Kameyama R, et al. Detection of hepatocellular carcinoma using 11C-choline PET: comparison with 18F-FDG PET. J Nucl Med. 2008;49:1245-1248.
47
Filippi L, Schillaci O, Bagni O. Recent advances in PET probes for hepatocellular carcinoma characterization. Expert Rev Med Devices. 2019;16:341-350.
48
Kwee SA, Sato MM, Kuang Y, et al. [18F]Fluorocholine PET/CT Imaging of Liver Cancer: Radiopathologic Correlation with Tissue Phospholipid Profiling. Mol Imaging Biol. 2017;19:446-455.
49
Bertagna F, Bertoli M, Bosio G, et al. Diagnostic role of radiolabelled choline PET or PET/CT in hepatocellular carcinoma: a systematic review and meta-analysis. Hepatol Int. 2014;8:493-500.
50
Treglia G, Giovannini E, Di Franco D, et al. The role of positron emission tomography using carbon-11 and fluorine-18 choline in tumors other than prostate cancer: a systematic review. Ann Nucl Med. 2012;26:451-461.
51
Talbot JN, Michaud L, Grange JD, et al. Use of choline PET for studying hepatocellular carcinoma. Clin Transl Imaging. 2014;2:103-113.
52
Talbot JN, Gutman F, Fartoux L, et al. PET/CT in patients with hepatocellular carcinoma using [(18)F]fluorocholine: preliminary comparison with [(18)F]FDG PET/CT. Eur J Nucl Med Mol Imaging. 2006;33:1285-1289.
53
Wu HB, Wang QS, Li BY, Li HS, Zhou WL, Wang QY. F-18 FDG in conjunction with 11C-choline PET/CT in the diagnosis of hepatocellular carcinoma. Clin Nucl Med. 2011;36:1092-1097.
54
Castilla-Lièvre MA, Franco D, Gervais P, et al. Diagnostic value of combining ¹¹C-choline andF-FDG PET/CT in hepatocellular carcinoma. Eur J Nucl Med Mol Imaging. 2016;43:852-859.
55
Fartoux L, Balogova S, Nataf V, et al. A pilot comparison of 18F-fluorodeoxyglucose and 18F-fluorocholine PET/CT to predict early recurrence of unifocal hepatocellular carcinoma after surgical resection. Nucl Med Commun. 2012;33:757-765.
56
Hartenbach M, Weber S, Albert NL, et al. Evaluating Treatment Response of Radioembolization in Intermediate-Stage Hepatocellular Carcinoma Patients Using 18F-Fluoroethylcholine PET/CT. J Nucl Med. 2015;56:1661-1666.
57
Salem N, Kuang Y, Wang F, Maclennan GT, Lee Z. PET imaging of hepatocellular carcinoma with 2-deoxy-2[18F]fluoro-D-glucose, 6-deoxy-6[18F] fluoro-D-glucose, [1-11C]-acetate and [N-methyl-11C]-choline. Q J Nucl Med Mol Imaging. 2009;53:144-156.
58
Bieze M, Klümpen HJ, Verheij J, et al. Diagnostic accuracy of (18) F-methylcholine positron emission tomography/computed tomography for intra- and extrahepatic hepatocellular carcinoma. Hepatology. 2014;59:996-1006.
59
Hwang KH, Choi DJ, Lee SY, Lee MK, Choe W. Evaluation of patients with hepatocellular carcinomas using [(11)C]acetate and [(18)F]FDG PET/CT: A preliminary study. Appl Radiat Isot. 2009;67:1195-1198.
60
Lhommel R, Annet L, Bol A, et al. PET scan with 11C-acetate for the imaging of liver masses: report of a false positive case. Eur J Nucl Med Mol Imaging. 2005;32:629.
61
Cheung TT, Ho CL, Lo CM, et al. 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. J Nucl Med. 2013;54:192-200.
62
Li S, Peck-Radosavljevic M, Ubl P, et al. The value of [11C]-acetate PET and [18F]-FDG PET in hepatocellular carcinoma before and after treatment with transarterial chemoembolization and bevacizumab. Eur J Nucl Med Mol Imaging. 2017;44:1732-1741.
63
Wang H, Zhu W, Ren S, et al. 68Ga-FAPI-04 Versus 18F-FDG PET/CT in the Detection of Hepatocellular Carcinoma. Front Oncol. 2021;11:693640.
64
Shi X, Xing H, Yang X, et al. Fibroblast imaging of hepatic carcinoma with 68Ga-FAPI-04 PET/CT: a pilot study in patients with suspected hepatic nodules. Eur J Nucl Med Mol Imaging. 2021;48:196-203.
65
Shi X, Xing H, Yang X, et al. Comparison of PET imaging of activated fibroblasts and 18F-FDG for diagnosis of primary hepatic tumours: a prospective pilot study. Eur J Nucl Med Mol Imaging. 2021;48:1593-1603.
66
Guo W, Pang Y, Yao L, et al. Imaging fibroblast activation protein in liver cancer: a single-center post hoc retrospective analysis to compare [68Ga]Ga-FAPI-04 PET/CT versus MRI and [18F]-FDG PET/CT. Eur J Nucl Med Mol Imaging. 2021;48:1604-1617.
67
Sharma P, Singh SS, Gayana S. Fibroblast Activation Protein Inhibitor PET/CT: A Promising Molecular Imaging Tool. Clin Nucl Med. 2021;46:e141-e150.
68
Siripongsatian D, Promteangtrong C, Kunawudhi A, et al. Comparisons of Quantitative Parameters of Ga-68-Labelled Fibroblast Activating Protein Inhibitor (FAPI) PET/CT and [18F]F-FDG PET/CT in Patients with Liver Malignancies. Mol Imaging Biol. 2022;24:818-829.
69
Zhang J, He Q, Jiang S, et al. [18F]FAPI PET/CT in the evaluation of focal liver lesions with [18F]FDG non-avidity. Eur J Nucl Med Mol Imaging. 2023;50:937-950.
70
Geist BK, Xing H, Wang J, et al. A methodological investigation of healthy tissue, hepatocellular carcinoma, and other lesions with dynamic 68Ga-FAPI-04 PET/CT imaging. EJNMMI Phys. 2021;8:8.
71
Shah RP, Laeseke PF, Shin LK, Chin FT, Kothary N, Segall GM. Limitations of Fluorine 18 Fluoromisonidazole in Assessing Treatment-induced Tissue Hypoxia after Transcatheter Arterial Embolization of Hepatocellular Carcinoma: A Prospective Pilot Study. Radiol Imaging Cancer. 2022;4:e210094.