Combined ¹⁸ F-FDG and ¹¹ C-Methionine PET/CT scans in a case of metastatic hepatocellular carcinoma

Abstract

A 37-year-old male who underwent a central hepatectomy of the liver for hepatocellular carcinoma (HCC) was referred for an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) study to rule out tumor recurrence or metastases. The scan showed a recurrent hepatic mass at the operative site, along with low-grade uptake in bilateral pulmonary metastases, mediastinal and hilar lymph nodes, and few skeletal sites. A non-FDG avid intracranial extradural mass was visualized in the right frontal lobe. The 11C-methionine PET/CT scan performed subsequently revealed a larger area of involvement at the primary site, along with widespread metastases to the lungs, mediastinal, hilar, and abdominal lymph nodes, and multiple skeletal sites. Further, dural metastasis with high tracer uptake was noted in the frontal region. To the best of our knowledge, this is the first case documented in the literature, wherein 11C-methionine PET/CT played a significant role in delineating the widespread dissemination, including the extremely rare dural involvement in a case of HCC. This report highlights the potential value of 11C-methionine PET/CT in assessing the hepatic and extrahepatic tumor burden in cases of HCC, especially in clinically unexpected locations.

Application of Different Imaging Methods in the Early Diagnosis of Primary Hepatic Carcinoma

“…After injection of gadolinium diethylenetriamine pentaacetic (Gd-DTPA) [ 26 ], MRI scanning could clearly show the blood perfusion of tumors. Golfieri et al [ 27 ] found that the newly introduced MRI contrast agent Gd-DTPA had enabled the signal enhancement of tumor vascular during the hepatobiliary phase (HBP) ( Figure 2(b) ), and it could help to detect and characterize small HCCs.…”

PET imaging of hepatocellular carcinoma with anti-1-amino-3-[18F]fluorocyclobutanecarboxylic acid in comparison with l-[S-methyl-11C]methionine

“…1a) was tested for HCC imaging [5, 6]. Although the initial clinical study showed a high uptake of [ 11 C] Met in HCC [6, 7], the 20-min short half-life of 11 C decay limited further clinical development of [ 11 C]Met for liver cancer applications. The non-natural amino acids provided an alternative.…”

Application of Computed Tomography Virtual Noncontrast Spectral Imaging in Evaluation of Hepatic Metastases

“…At present, there are many detection and qualification imaging methods for hepatic metastases, commonly ultrasonography, contrast-enhanced computed tomography (CT), contrast-enhanced magnetic resonance imaging, and positron emission tomography/CT. [ 2 3 4 ] Contrast-enhanced CT has high-density resolution, and the capabilities of acquiring the images of arterial, portal venous, and equilibrium phases, analyzing the hemodynamics of arteries and veins in hepatic metastases, and providing such important information as the size, number, enhancement degree, and distribution of metastases. However, ionizing radiation during CT scanning exposes patients to a certain health risk.…”