J Korean Soc Radiol.  2020 Nov;81(6):1424-1435. 10.3348/jksr.2019.0154.

Usefulness of 18 F-FDG PET/CT and Multiphase CT in the Differential Diagnosis of Hepatocellular Carcinoma and Combined Hepatocellular CarcinomaCholangiocarcinoma

Affiliations
  • 1Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
  • 2Department of Nuclear Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.

Abstract

Purpose
The purpose of this study was to evaluate the usefulness of multiphasic CT and 18 F-fluorodeoxyglucose (FDG) PET/CT for the differentiation of combined hepatocellular carcinomacholangiocarcinoma (cHCC-CCA) from hepatocellular carcinoma (HCC).
Materials and Methods
From January 2007 to April 2016, 93 patients with pathologically confirmed HCC (n = 84) or cHCC-CCA (n = 9) underwent CT and PET/CT imaging. Contrast enhancement patterns were divided into three types based on the attenuation of the surrounding liver parenchyma: type I (early arterial enhancement with delayed washout), type II (early arterial enhancement without delayed washout), and type III (early hypovascular, infiltrative appearance, or peripheral rim enhancement).
Results
cHCC-CCAs (89%) had a higher PET/CT positive rate than did HCCs (61%), but the PET/ CT positive rate did not differ significantly (p = 0.095). Among the 19 cases of the type II enhancement pattern, 3 (21%) of 14 HCCs and 4 (80%) of 5 cHCC-CCAs were PET/CT positive. cHCC-CCAs had a significantly higher PET/CT positive rate (p = 0.020) in the type II enhancement pattern.
Conclusion
The PET/CT positive rate of cHCC-CCA was significantly higher than that of HCC in lesions with a type II enhancement pattern. The 18 F-FDG PET/CT can be useful for the differentiation of cHCCCCA from HCC in lesions with a type II enhancement pattern on multiphasic CT.

Keyword

Carcinoma; Hepatocellular; Positron Emission Tomography Computed Tomography; Tomography; X-Ray Computed
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