Positron-emission tomography for hepatocellular carcinoma: Current status and future prospects

Abstract

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer mortality worldwide. Various imaging modalities provide important information about HCC for its clinical management. Since positron-emission tomography (PET) or PET-computed tomography was introduced to the oncologic setting, it has played crucial roles in detecting, distinguishing, accurately staging, and evaluating local, residual, and recurrent HCC. PET imaging visualizes tissue metabolic information that is closely associated with treatment. Dynamic PET imaging and dual-tracer have emerged as complementary techniques that aid in various aspects of HCC diagnosis. The advent of new radiotracers and the development of immuno-PET and PET-magnetic resonance imaging have improved the ability to detect lesions and have made great progress in treatment surveillance. The current PET diagnostic capabilities for HCC and the supplementary techniques are reviewed herein.

Uncovering the Mechanisms of Cryptotanshinone as a Therapeutic Agent Against Hepatocellular Carcinoma

“…However, most patients are typically diagnosed at an advanced stage with severe comorbidities, making them unsuitable for surgery. At more advanced stages, the overall survival rate can be improved by sorafenib treatment, but this is associated with significant side effects and potential toxicity ( Ayoub et al, 2019 ; Inchingolo et al, 2019 ; Lu et al, 2019 ). As such, there is an urgent need to develop novel HCC therapeutic strategies.…”

Evaluation of Hybrid PET/MRI for Gross Tumor Volume (GTV) Delineation in Liver Cancer Radiotherapy

“…In moderately and well-differentiated hepatocellular carcinoma (HCC), studies have con rmed that high FDG-6-phosphatase activity, high expression of p-glycoprotein, and low expression of GLUT1 or GLUT2 lead to low uptake of 18 F-FDG [6]. High levels of FDG-6-phosphatase hydrolyze intracellular FDG-6-phosphate into FDG, which is then transported outside the cells.…”

“…P-glycoprotein acts as an e ux, and its high expression of it also transports more FDG out of the cells. GLUT1, GLUT3, and GLUT12 are involved in the transport of 18 F-FDG into cancer cells [6], and their low expression reduces the uptake of FDG. All these factors contribute to a lower accumulation of FDG in HCC.…”

“…CT or MRI alone can show the anatomical features of the tumor but not the biological behavior, while 18 F-FDG PET images can re ect the glycolytic metabolic behavior of the tumor. In addition to its widespread use in the diagnoses, staging, therapeutic evaluation, and posttreatment surveillance of patients with liver cancer [5,6,7], 18 F-uorodeoxyglucose positron emission tomography ( 18 F-FDG PET) has recently increasingly been used in the delineation of target volumes for radiotherapy. The major disadvantages of PET/CT are the relatively high radiation exposure from the two components and the relatively low spatial resolution of PET data.…”

Role of imaging in management of hepatocellular carcinoma: surveillance, diagnosis, and treatment response

“…The use of positron-emission tomography (PET) has been evaluated for diagnosis of HCC but has not produced favorable results for detection of primary tumors. The most widely used radiotracer is 18 F-fluorodeoxy-6-glucose phosphate (FDG), which has added utility in assessing metabolic cellular function, but 18 F-FDG uptake in PET/CT for primary HCC has only been seen in 40% of cases [ 65 ] . This is due to high 18 F-FDG uptake by both normal hepatocytes and malignant neoplastic cells associated with HCC, resulting in difficulty in identifying HCC lesions [ 66 , 67 ] .…”