Heterogeneous Uptake of 18F-FDG and 68Ga-PSMA-11 in Hepatocellular Carcinoma

Abstract

We present the case of an 87-year-old man with a history of melanoma metastatic to the lungs found to have an FDG-negative liver lesion that was initially thought to be benign. Follow-up CT revealed growth of the liver lesion despite excellent response to nivolumab therapy of the pulmonary melanoma metastases. Biopsy of the lesion confirmed primary hepatocellular carcinoma. Follow-up 18F-FDG PET/CT showed minimal FDG uptake, slightly above liver background, and subsequent 68Ga-PSMA-11 PET/MR showed focal, intense uptake of radiotracer in a different region of the tumor. These imaging findings support intratumor metabolic heterogeneity with radiotracer uptake in different tumor locations.

Prostate-specific membrane antigen expression in hepatocellular carcinoma: potential use for prognosis and diagnostic imaging

“…Our case of radionuclide PSMA-diagnostic demonstrates feasibility and efficacy of this modality in a patient with HCC, even after several lines of therapy. One recently published case series (n=7) with majority of patients being therapy-naïve shows similar results with multiple liver lesions, several of them also with PSMA positive metastatic lesions, corroborated by several other published case reports [7,9,10,17]. At that, benign liver conditions (regenerative nodules) in showed only low levels of expression similar to our results which emphasize the potential theranostic role of PSMA in HCC.…”

Prostate-specific membrane antigen expression in hepatocellular carcinoma: potential use for prognosis and diagnostic imaging

“…Our case of radionuclide PSMAdiagnostic demonstrates feasibility and efficacy of this modality in a patient with HCC, even after several lines of therapy. One recently published case series (n=7) with majority of patients being therapy-naïve shows similar results with multiple liver lesions, several of them also with PSMA positive metastatic lesions, corroborated by several other published case reports [7,9,10,17]. At that, benign liver conditions (regenerative nodules) in showed only low levels of expression similar to our results which emphasize the potential theranostic role of PSMA in HCC.…”

Radiolabelled PSMA PET/CT or PET/MRI in hepatocellular carcinoma (HCC): a systematic review

“…The majority of HCC shows high levels of PSMA expression on tumor vessels and on canalicular membrane of cells [26,28] and therefore important implications for PSMAtargeted imaging and therapy arise. PSMA-targeted imaging of HCC in clinical practice has been evaluated only by a few studies and most of these studies are case reports [22,23,[27][28][29][30][31][32][33][34], probably because of the small number of centers that currently use radiolabelled PSMA PET/CT or PET/ MRI, resulting in a reduction of the population of patients overall studied.…”

“…A total of 55 articles were extrapolated with the computer literature search and by reviewing the titles and abstracts 43 of them were excluded because the reported data were not within the field of interest of this review. Twelve articles were selected and retrieved in full-text version [22][23][24][25][26][27][28][29][30][31][32][33]; one additional study was found screening the references of these articles [34]. A total of 13 articles were then included in the systematic review [22][23][24][25][26][27][28][29][30][31][32][33][34] (Fig.…”