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Awali M, El Homsi M, Fraum TJ, Shetty AS, Ponisio MR, Gharzeddine K, Mhlanga J, Mallak N, Behr S, Itani M. PET/MRI: pictorial review of hepatobiliary and pancreatic applications. Abdom Radiol (NY) 2025; 50:875-901. [PMID: 39254711 DOI: 10.1007/s00261-024-04548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/11/2024]
Abstract
PET and MRI both play valuable roles in the management of hepatobiliary and pancreatic (HBP) malignancies. Simultaneous PET/MRI combines the excellent soft-tissue resolution and anatomic details from MRI with functional information from PET in a single comprehensive examination. MRI is the main imaging modality in evaluating HCC, playing important roles in screening, characterization, local extent, and evaluating tumor response, whereas 18F-fluorodeoxyglucose (FDG) PET can help evaluate for lymph node involvement and metastatic disease. In cholangiocarcinoma and pancreatic malignancies, both PET and MRI have excellent utility in initial staging as well as assessing treatment response. In all HBP malignancies, FDG-PET/MRI is a unique problem-solving tool in complex cases and diagnostic challenges, especially after locoregional therapy and when differentiating residual or recurrent viable disease from inflammatory and other benign processes. In this manuscript, we review the role of PET/MRI in the diagnosis, staging, assessing treatment response, and characterizing post-treatment processes. With the introduction of multiple new tracers, the value of PET/MRI has not yet been fully realized, and more studies are needed to demonstrate the utility and efficacy of PET/MRI in improving patient care in hepatobiliary and pancreatic oncology.
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Affiliation(s)
- Mohamed Awali
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Blvd, Box 8131, St Louis, MO, 63110, USA
| | - Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Blvd, Box 8131, St Louis, MO, 63110, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Blvd, Box 8131, St Louis, MO, 63110, USA
| | - Maria R Ponisio
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Blvd, Box 8131, St Louis, MO, 63110, USA
| | - Karem Gharzeddine
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Joyce Mhlanga
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Blvd, Box 8131, St Louis, MO, 63110, USA
| | - Nadine Mallak
- Department of Diagnostic Radiology, Oregon Health & Sciences University, 3181 Southwest Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Spencer Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Room M 372, Box 0628, San Francisco, CA, 94143, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Blvd, Box 8131, St Louis, MO, 63110, USA.
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Jiang H, Tian M. Cancer. TRANSPATHOLOGY 2024:297-305. [DOI: 10.1016/b978-0-323-95223-1.00009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Yao Y, Civelek AC, Li XF. The application of 18F-FDG PET/CT imaging for human hepatocellular carcinoma: a narrative review. Quant Imaging Med Surg 2023; 13:6268-6279. [PMID: 37711813 PMCID: PMC10498267 DOI: 10.21037/qims-22-1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/20/2023] [Indexed: 09/16/2023]
Abstract
Background and Objective Primary hepatocellular carcinoma (HCC) poses a significant threat to human health. The mean overall survival (OS) of HCC is approximately 15.8 months whereas the 6-month and 1-year OS rates are only 71.6% and 49.7%, respectively. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has been widely used for the management of several solid cancers; however, HCC frequently displays low 18F-FDG uptake; approximately 50% of HCC cases do not take up 18F-FDG. Therefore, 18F-FDG PET is not considered very useful for the visualization of HCC and is not currently a recommended standard imaging modality for HCC. Conversely, 18F-FDG PET/CT has been reported to be clinically important in the management, staging, and prognosis of HCC patients. Currently, reports relating to 18F-FDG uptake in HCC are unclear and controversial. There is an urgent need to clarify the efficacy of 18F-FDG PET for the management of HCC. Methods The PubMed database was searched for all articles on the application of 18F-FDG PET/CT imaging for human HCC up to December 2021. The following search terms were used: 'Hepatocellular carcinoma', '[18F]FDG PET/CT', 'Hypoxia', '[11C]Choline'. Key Content and Findings In this review, we re-evaluate the potential hypoxia-dependent uptake mechanism of 18F-FDG in HCC and review the usefulness of 18F-FDG PET/CT for identifying, managing, and investigating the biological properties of HCC. Conclusions 18F-FDG PET/CT is very useful for HCC visualization, management, and the evaluation of biological properties. A negative test for 18F-FDG uptake is not meaningless and may reflect a relatively better outcome. 18F-FDG-positive lesions indicate a significantly less favorable prognosis.
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Affiliation(s)
- Yong Yao
- Department of Nuclear Medicine, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Clinical Medicine Postdoctoral Research Station, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - A. Cahid Civelek
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Xiao-Feng Li
- Department of Nuclear Medicine, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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Gnanasegaran G, Agrawal K, Wan S. 18F-Fluorodeoxyglucose-PET-Computerized Tomography and non-Fluorodeoxyglucose PET-Computerized Tomography in Hepatobiliary and Pancreatic Malignancies. PET Clin 2022; 17:369-388. [PMID: 35717098 DOI: 10.1016/j.cpet.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Molecular imaging with PET-computerized tomography (PET-CT) plays an important role in oncology. There is current and evolving evidence supporting the use of fluorodeoxyglucose (FDG) and non-FDG tracers in assessment patients with hepatobiliary and pancreatic cancers in various clinical scenarios. In this chapter, we discuss the advantages and limitations of FDG and non-FDG PET-CT in the management of patients with hepatobiliary and pancreatic cancers.
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Affiliation(s)
| | | | - Simon Wan
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Kan X, Ren Y, Li X, Kong X, Zhang Y, Li Q, Liu F, Zhang Y, Zheng C. Value of 18F-FDG PET/MRI in the early evaluation of treatment response following radiofrequency ablation of liver cancer in a rabbit model. J Vasc Interv Radiol 2021; 33:452-459.e3. [PMID: 34607002 DOI: 10.1016/j.jvir.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To test the hypothesis that 18F-fluorodeoxyglucose positron emission tomography and MRI (18F-FDG PET/MRI) can detect early residual tumor following radiofrequency ablation (RFA) of liver cancer using a VX2 tumor model. METHODS Twenty-four rabbits with VX2 liver tumors were randomly divided into three groups (n = 8/group): group 1 without RFA treatment, group 2 with complete ablation, and group 3 with partial ablation. 18F-FDG PET/MRI scan was obtained in three animal groups within 2 hours post-RFA. The maximum standardized uptake value (SUVmax) of non-treated liver tumor, benign peri-ablational enhancement (BPE), residual tumor, ablated tumor, adjacent liver parenchyma, and mean SUV of normal liver were measured, respectively. The ratios of SUVmax for these targets to mean SUV of normal liver (TNR) were calculated and statistically compared. RESULTS The mean TNR of non-treated liver tumors in group 1 was significantly greater than that of adjacent liver parenchyma (8.68 ± 0.71 vs 1.89 ± 0.26, p < 0.001). In group 2, the mean TNR of BPE was significantly greater than that of adjacent liver parenchyma (2.85 ± 0.20 vs 1.86 ± 0.25, p < 0.001). In group 3, the mean TNR of residual tumor was significantly greater than that of BPE (8.64 ± 0.59 vs 2.78 ± 0.23, p < 0.001), which was significantly greater than that of completely ablated tumor (2.78 ± 0.23 vs 0.50 ± 0.06, p < 0.001). CONCLUSION 18F-FDG PET/MRI may serve as a promising imaging tool for early detection of viable residual tumors due to incomplete tumor ablation.
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Affiliation(s)
- Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yanqiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yanrong Zhang
- Neuroradiology Section, Department of Radiology, Stanford University, Stanford, California, USA
| | - Qian Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yajing Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan 430022, China.
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