رحلات

سورة البقرة آية 32.

Role of PET CT in assessment of HCC patients after therapeutic intervention compared to DW MRI.

Under Supervision of. Dr. Hosam Abdelkader Morsy Professor of Radiodiagnosis Faculty of Medicine - Ain Shams University.

Acknowledgement.

Introduction.

. . . Application of medical imaging in cancer patients has expanded from diagnosis and staging to screening , treatment guidance and therapeutic monitoring ..

. . . Functional imaging is a medical imaging technique of detecting changes in metabolism, blood flow, regional chemical composition, and absorption..

. . Introduction. Metabolic imaging with 18F-FDG PET/CT has been a very successful modality for detection, staging and restaging various cancers with excellent sensitivity and specificity in certain cancers..

. . Introduction. Hepatocellular carcinoma (HCC) is the sixth most common malignant tumor and the third most common cause of cancer-related deaths in males and females worldwide..

. . Introduction. Advances in therapeutic options make curative treatment possible for almost a third of patients if the cancer was detected in its early stage, by surgical resection and/or locoregional interventions , such as RFA or TACE..

. . Introduction. Thus, the evaluation of tumor response after therapeutic interventions is essential in directing management in HCC, as providing a more aggressive locoregional therapy or a concomitant treatment using another modality, in order to improve survival rates..

Aim of the Work.

To assess the benefits of using the metabolic parameters of 18F-FDG PET/CT in follow up of HCC patients after therapeutic intervention, in comparison to Diffusion MRI..

Patients and Methods.

Patients and Methods. Patients. This is a retrospective study, conducted from January 2017 to September 2021 on 32 patients known to have HCC presented for radiological follow-up after therapeutic interventions to search for residual/recurrent neoplasia or metastasis..

abstract. Inclusion criteria. Regular follow up post therapy..

abstract. Exclusion criteria. Contraindications for MRI ..

Patients and Methods. Patient preparation. All patients were asked to fast at least 6 h prior to scan with good hydration ..

Patients and Methods. To avoid physiologic muscle uptake of FDG , the patients were instructed to avoid any kind of strenuous activity prior to the examination (for a minimum of 24 h) and following injection of the radiotracer ..

Patients and Methods. Technique:. For the PET/CT : We performed non-enhanced low-dose CT scan first and then whole-body PET scan..

Patients and Methods. Image interpretation. The findings were correlated with the findings derived from triphasic contrast-enhanced CT images according to the American Association for the Study of Liver Diseases (AASLD) and LI-RADS v2018:.

Patients and Methods. Qualitative assessment of the main followed lesions in both PET/CT and DW MR images was done visually according to the 18F-FDG accumulation, and the degree of brightness within the main followed lesion or operative bed in surgically treated lesions and any de novo lesions in comparison with the surrounding normal liver tissue, whether visually increased or not..

Patients and Methods. Quantitative assessment of the main lesions was done by identifying areas of pathologically increased FDG uptake -avoiding physiologic uptake-, and measuring maximal standardized uptake value ( SUVmax ) on the area of maximal metabolic activity, and measuring the ADC mean value at the MR study ..

Patients and Methods. The maximum standardized uptake value ( SUVmax ) & the apparent diffusion coefficient (ADC) mean value were applied for the main followed lesions only ..

Cases & Results.

Results. A 66-year-old female patient. H istory of segment VII HCC, had TACE. LR-TR viable lesion. I ncreased FDG uptake … Diffusion restriction . No de novo lesions. Mildly active metastatic pulmonary nodule..

Results. Case 2. . abstract. abstract. The Fused PET/CT (F) and PET images(G): show no visually increased FDG uptake in the ablated HCC (white arrow) achieving SUV max of 2.2 ..

Results. A 56-year-old male patient with a history of two HCCs, the first at segment V, underwent TACE, and the second at segments VI/VII subcapsular , had RFA. Both were LR-TR non-viable. Visually increased peripheral FDG uptake…Diffusion restriction . No definite de novo lesions. No detected metastatic lesions..

According to our results: Qualitative assessment diagnostic performance of DW-MRI and PET-CT in detecting residual active viable HCC..

After adding the Quantitative assessment the diagnostic performance was as follows:.

Conclusion.

Conclusion. 18F-FDG PET/CT and DW MRI are effective functional imaging modalities for assessment of HCC patients after therapeutic intervention..

Conclusion. On the other hand, the PET/CT was much better in detecting distant metastases and adding T riphasic CT images to the standard PET/CT protocol will be of great diagnostic benefit with neither additional risks nor costs upon the patient ..

abstract. Take Home Message. Following therapeutic intervention of HCC, on suspecting local residual or recurrent tumoral tissue, the imaging modality of choice should be MRI with basic anatomical and dynamic sequences, and also functional images involving DWIs and ADC, however , if distant metastasis is suspected, or liver transplantation is intended, then PET/CT is the imaging modality of choice..