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Case Reports
. 2024 Dec 4;16(12):e75097.
doi: 10.7759/cureus.75097. eCollection 2024 Dec.

Contrasting Molecular Imaging Findings in Hepatocellular Carcinoma Using Dual Positron Emission Tomography Modalities

Ahmed Abdlkadir  1 , Obayda Rabei  1 , Ula Al-Rasheed  1 , Akram Al-Ibraheem  1
Affiliations
Case Reports

Contrasting Molecular Imaging Findings in Hepatocellular Carcinoma Using Dual Positron Emission Tomography Modalities

Ahmed Abdlkadir et al. Cureus. .

Abstract

Fibroblast activation protein (FAPI) has been recently incorporated as a molecular imaging radiotracer for the evaluation of epithelial neoplasms that support or complement the role of [18F]Fluorodeoxyglucose ([18F]FDG) in many cancer subtypes since its development. Both radiotracers have been shown to have diagnostic, prognostic, and predictive value for several neoplasms. Herein, we present a 73-year-old male patient with a complex medical and oncological history who was recently diagnosed with hepatocellular carcinoma (HCC). Both [18F]FDG and [68Ga]Ga-FAPI-04 revealed distinct molecular imaging characteristics. A large segment 8 hepatic mass was observed via [18F]FDG positron emission computed tomography (PET/CT), whereas [68Ga]Ga-FAPI PET/CT revealed a large hepatic mass confined to segment 8, exhibiting complete photopenia. Overall, T2N0M0 stage II HCC disease was affirmed. The patient underwent two rounds of transarterial chemoembolization, which resulted in partial disease control and symptomatic control. To our knowledge, this case represents the first imaging instance to capture such unique molecular characteristics of HCC via a dual PET/CT approach composed of [18F]FDG and [68Ga]Ga-FAPI radiotracers.

Keywords: 18f-fdg; 68ga-fapi; hcc; isometabolism; pet/ct; photopenia.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Baseline abdominal CT
Coronal, and axial hepatic views of abdominal CT depicted a large 7.5 cm segment VIII hepatic mass (arrows).
Figure 2
Figure 2. Baseline [18F]FDG PET/CT
(A-E) Maximum intensity projection [18F]FDG image, fused coronal, and axial PET/CT views depicted the hepatocellular carcinoma lesion as an isometabolic segment VII hypodensity with otherwise unmarkable scan elsewhere (asterisks). FDG: Fluorodeoxyglucose
Figure 3
Figure 3. Baseline [68Ga]Ga-FAPI PET/CT
(A-E) Maximum intensity projection [68Ga]Ga-FAPI, fused coronal, and axial PET/CT views depicted the hepatocellular carcinoma lesion as photopenic segment VII hypodensity with otherwise unmarkable scan elsewhere (arrowheads). FAPI: Fibroblast activation protein inhibitor
Figure 4
Figure 4. Follow-up abdominal CT
(A, B) Partial tumor shrinkage and interval coalification were observed following transretinal chemoembolization (curved arrows).
See this image and copyright information in PMC

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