Nuclear imaging for functional evaluation and theragnosis in liver malignancy and transplantation

Abstract

Currently, nuclear imaging such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) is increasingly used in the management of liver malignancy. (18)F-fluorodeoxyglucose (FDG)-PET is the most widely used nuclear imaging in liver malignancy as in other cancers, and has been reported to be effective in diagnosis, response monitoring, recurrence evaluation, and prognosis prediction. Other PET imaging such as (11)C-acetate PET is also used complementarily to FDG-PET in diagnosis of liver malignancy. Additionally, image-based evaluation of regional hepatic function can be performed using nuclear imaging. Those imaging modalities are also effective for candidate selection, treatment planning, and perioperative evaluation in liver surgery and transplantation. Recently, nuclear imaging has been actively adopted in the transarterial radioembolization therapy of liver malignancy, according to the concept of theragnosis. With the development of new hybrid imaging technologies such as PET/magnetic resonance imaging and SPECT/CT, nuclear imaging is expected to be more useful in the management of liver malignancy, particularly regarding liver surgery and transplantation. In this review, the efficacy and roles of nuclear imaging methods in diagnosis, transplantation and theragnosis are discussed.

Keywords: Liver malignancy; Nuclear imaging; Positron emission tomography-computed tomography; Theragnosis; Transplantation.

Figure 1

¹⁸F-fluorodeoxyglucose-positron emission tomography in hepatocellular carcinoma. ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (CT) fusion (A) and CT (B) images show hot uptake in the primary lesion (arrow) in the right lobe of the liver and regional lymph node metastases (arrowhead).

Figure 2

¹⁸F-fluorodeoxyglucose and ¹¹C-acetate positron emission tomography in hepatocellular carcinoma. In a patient with HCC, maximal intensity projection (A), PET (B), and PET/CT fusion (C) images of ¹⁸F-fluorodeoxyglucose-PET does not show a lesion of hot uptake. However, the same image set of ¹¹C-acetate PET (D-F) shows hot uptake in the S7 segment of the liver. PET: Positron emission tomography; HCC: Hepatocellular carcinoma; CT: Computed tomography.

Figure 3

A Bremsstrahlung scan of ⁹⁰Y-microsphere transarterial radioembolization. Anterior (A) and posterior (B) planar scan images show hot uptake (arrows) in the right lobe of the liver, which is well correlated with findings on angiography (C), in spite of relatively poor image quality with blurring. Some liver-to-lung shunt activities are shown in the lungs (arrowheads).

Figure 4

Pretreatment planning and post-treatment evaluation using single photon emission computed tomography and positron emission tomography. In a patient with a large hypervascular tumor in the right lobe of the liver (A; contrast-enhanced CT), pretreatment SPECT/CT using ^99mTc-labeled macroaggregated albumin shows well-localized accumulation of the radiotracer (B). After treatment evaluation using ⁹⁰Y-microsphere, ⁹⁰Y PET/CT image shows a similar uptake pattern in the liver (C). SPECT: Single photon emission computed tomography; CT: Computed tomography; PET: Positron emission tomography.