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Nuklearmedizin 1998; 37(08): 279-285
DOI: 10.1055/s-0038-1632349
Originalarbeiten — Original Articles
Schattauer GmbH

Limited Value of Fluorine-18-Fluorodeoxyglucose PET for the Differential Diagnosis of Focal Liver Lesions in Patients with Chronic Hepatitis C Virus Infection

Eingeschränkte Wertigkeit der Fluor-18-FDG-PET in der Differentialdiagnostik fokaler Leberläsionen bei Patienten mit chronischer Hepatitis C
O. Schröder
1   Department of Nuclear Medicine (Director: Prof. Dr. G. Hör
2   22nd Department of Internal Medicine, (Director: Prof. Dr. W. F. Caspary) Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
,
J. Trojan
2   22nd Department of Internal Medicine, (Director: Prof. Dr. W. F. Caspary) Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
,
S. Zeuzem
2   22nd Department of Internal Medicine, (Director: Prof. Dr. W. F. Caspary) Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
,
R. P. Baum
1   Department of Nuclear Medicine (Director: Prof. Dr. G. Hör
› Author Affiliations
Further Information

Publication History

Received: 22 May 1998

in revised form: 10 August 1998

Publication Date:
03 February 2018 (online)

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Summary

Aim: The differentiation of HCC from liver metastasis or benign disorders by imaging studies based upon morphological aspects may be difficult. Method: In order to evaluate the role of tumour metabolism, we performed FDG-PET (whole-body PET and transmission-corrected regional scans of the liver as well as the SUV determined 60 min after injection of FDG) in ten consecutive patients with HCV-associated focal liver lesions. Definite diagnosis was established after ultrasound-guided liver biopsy followed by histopathological examination. These results were compared with ultrasound, computed tomography, serum anti- p53, and p53 protein expression. Results: The histologic examination revealed a HCC in five patients, regenerative nodules in three patients, and liver metastasis (primary malignancy: one adenocarcinoma and one neuroendocrine tumour) in the remaining two patients. Three of ten lesions were detectable by FDG-PET: two HCCs and one metastatic adenocarcinoma. Seven lesions were not distinguishable by FDG-PET (three HCCs, three regeneration nodules and one metastatic neuroendocrine tumour). In each patient hepatic lesions were visible either by ultrasound or CT. Both tumours (metastatic adenocarcinoma, moderately well-differentiated HCC) with the strongest expression of p53 also presented with highly increased FDG uptake. Conclusions: FDG-PET is not superior to ultrasound or CT and therefore does not allow the non-invasive differentiation of HCV-associated focal liver lesions. Tissue-diagnosis by means of liver-biopsy followed by histopathological examination remains the gold-standard for the differentiation of HCV-related liver lesions. The finding of the relationship of p53 protein overexpression with the SUV needs further confirmation.

Zusammenfassung

Ziel: Eine Differenzierung des hepatozellulären Karzinoms (HCC) gegenüber Lebermetastasen oder benignen Erkrankungen ist durch Einsatz morphologischer bildgebender Verfahren nicht immer möglich. Untersuchungen über einen möglichen diagnostischen Zugewinn durch die Bestimmung des Glukosestoffwechsels mittels FDG-PET in der Evaluation fokaler Leberläsionen bei Patienten mit chronischer Hepatitis C liegen nicht vor. Methoden: An 10 Patienten wurden nach Injektion von 370 MBq FDG-Ganzkörper-PET sowie transmissionskorrigierte Regionalaufnahmen der Leber und SUV-Bestimmungen 60 Minuten nach i.v. Applikation von FDG durchgeführt. Parallel dazu erfolgten abdomineller Ultraschall, CT, Serum-anti-p53-Bestimmung sowie die histologische und p53-Antigen-immunhistochemische Aufarbeitung der fokalen Leberherde. Ergebnisse: Die histologische Untersuchung der sonographisch nachgewiesenen Leberherde ergab 5 HCC, 2 Lebermetastasen sowie 3 zirrhotische Regeneratknoten. Mit der FDG-PET konnten sowohl ein hepatisch metastasiertes Adeno-Ca des Rektums als auch 2/5 HCC detektiert werden. Alle benignen Leberläsionen, jedoch auch 3 HCC und das hepatisch metastasierte Karzinoid waren dagegen nicht nachweisbar. Mit Ultraschall oder CT gelang der Nachweis sämtlicher in- trahepatischer Prozesse. Beide Tumoren mit einer sehr starken Expression von p53 wiesen einen stark erhöhten Glukosemetabolismus auf. Schlußfolgerung: FDG-PET ist morphologischen bildgebenden Verfahren in der Detektion und der nichtinvasiven Differenzierung fokaler Leberläsionen bei Patienten mit HCV unterlegen. Die nachgewiesene Beziehung zwischen der p53-Expression und dem SUV bedarf weiterer Untersuchungen.

Keywords

Fluorine-18-fluorodeoxyglucose - PET - chronic hepatitis C - hepatocellular carcinoma - p53 protein

Schlüsselwörter

Fluor-18-Fluordeoxyglukose - PET - chronische Hepatitis C - hepatozellulä- res Karzinom - p53-Protein
 

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