BACKGROUND & AIMS Hepatocellular carcinoma (HCC) staging according to the Barcelona Clinical Liver Cancer (BCLC) classification is based on conventional imaging. The aim of our study was to assess the impact of dual-tracer 18F-fluorocholine and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) on tumor staging and treatment allocation. METHODS A total of 192 dual-tracer PET/CT scans (18F-fluorocholine and 18F-fluorodeoxyglucose PET/CT) were performed in 177 patients with HCC. BCLC staging and treatment proposal were retrospectively collected based on conventional imaging, along with any new lesions detected, and changes in BCLC classification or treatment allocation based on dual-tracer PET/CT. RESULTS Patients were primarily men (87.5%) with cirrhosis (71%) due to alcohol ± non-alcoholic steatohepatitis (26%), viral infection (62%) or unknown causes (12%). Among 122 patients with PET/CT performed for staging, BCLC stage based on conventional imaging was 0/A in 61 patients (50%), B in 32 patients (26%) and C in 29 patients (24%). Dual-tracer PET/CT detected new lesions in 26 patients (21%), upgraded BCLC staging in 14 (11%) and modified treatment strategy in 17 (14%). In addition, dual-tracer PET/CT modified the final treatment in 4/9 (44%) patients with unexplained elevation of alpha-fetoprotein (AFP), 10/25 patients (40%) with doubtful lesions on conventional imaging and 3/36 patients (8%) waiting for liver transplantation without active HCC after tumor response following bridging therapy. CONCLUSION When used for HCC staging, dual-tracer PET/CT enabled BCLC upgrading and treatment modification in 11% and 14% of patients, respectively. Dual-tracer PET/CT might also be useful in specific situations (an unexplained rise in AFP, doubtful lesions or pre-transplant evaluation of patients without active HCC). LAY SUMMARY Using a combination of tracers 18F-fluorocholine and 18F-fluorodeoxyglucose when performing positron emission tomography/computed tomography (PET/CT), often called a PET scan, helps to identify new tumor lesions in patients with hepatocellular carcinoma. This technique enabled staging modification of patients' tumors and led to changes in treatment allocation in certain patients.

中文翻译：

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18F-氟胆碱正电子发射断层扫描/计算机断层扫描改善肝细胞癌患者的肿瘤分期和治疗分配

背景和目的 根据巴塞罗那临床肝癌 (BCLC) 分类的肝细胞癌 (HCC) 分期是基于常规成像。我们研究的目的是评估双示踪剂 18F-氟胆碱和 18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描 (PET/CT) 对肿瘤分期和治疗分配的影响。方法 共对 177 名 HCC 患者进行了 192 次双示踪 PET/CT 扫描（18F-氟胆碱和 18F-氟脱氧葡萄糖 PET/CT）。BCLC 分期和治疗方案是基于常规影像学、检测到的任何新病变以及基于双示踪 PET/CT 的 BCLC 分类或治疗分配的变化回顾性收集的。结果 患者主要是男性 (87.5%) 因酒精引起肝硬化 (71%) ± 非酒精性脂肪性肝炎 (26%)，病毒感染 (62%) 或原因不明 (12%)。在 122 名进行 PET/CT 分期的患者中，基于常规成像的 BCLC 分期为 0/A 61 例（50%），B 32 例（26%），C 29 例（24%）。双示踪 PET/CT 检测到 26 名患者 (21%) 的新病变，14 名 (11%) 升级 BCLC 分期，17 名 (14%) 修改治疗策略。此外，双示踪 PET/CT 修改了 4/9 (44%) 不明原因甲胎蛋白 (AFP) 升高的患者、10/25 (40%) 例常规影像学上有可疑病变的患者和 3/ 36 名患者 (8%) 在桥接治疗后肿瘤反应后等待肝移植，但没有活动性 HCC。结论当用于 HCC 分期时，双示踪 PET/CT 分别在 11% 和 14% 的患者中启用了 BCLC 升级和治疗修改。双示踪 PET/CT 在特定情况下也可能有用（无法解释的 AFP 升高、可疑病变或非活动性 HCC 患者的移植前评估）。常规总结 在进行正电子发射断层扫描/计算机断层扫描 (PET/CT)（通常称为 PET 扫描）时，使用示踪剂 18F-氟胆碱和 18F-氟脱氧葡萄糖的组合有助于识别肝细胞癌患者的新肿瘤病变。该技术能够对患者的肿瘤进行分期修改，并导致某些患者的治疗分配发生变化。常规总结 在进行正电子发射断层扫描/计算机断层扫描 (PET/CT)（通常称为 PET 扫描）时，使用示踪剂 18F-氟胆碱和 18F-氟脱氧葡萄糖的组合有助于识别肝细胞癌患者的新肿瘤病变。该技术能够对患者的肿瘤进行分期修改，并导致某些患者的治疗分配发生变化。常规总结 在进行正电子发射断层扫描/计算机断层扫描 (PET/CT)（通常称为 PET 扫描）时，使用示踪剂 18F-氟胆碱和 18F-氟脱氧葡萄糖的组合有助于识别肝细胞癌患者的新肿瘤病变。该技术能够对患者的肿瘤进行分期修改，并导致某些患者的治疗分配发生变化。