Issues Pertaining to PET Imaging of Liver Cancer

Document Type : Short Communication


1 Professor of Radiology, Case Western Reserve University, Cleveland, OH, USA

2 Associate professor of Genetics, Case Western Reserve University, Cleveland, OH, USA


Positron emission tomography (PET) imaging using 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) has proven valuable in the diagnosis, staging and restaging for many cancers. However, its application for liver cancer has remained limited owing in part to the relatively high background uptake of the tracer in the liver plus the significant variability of the tumor specific uptake in liver cancer among patients. Thus, for primarily liver cancer, in particular, hepatocellular carcinoma (HCC), radio-tracers with better tumor-enhancing uptake/retention are still sought in order to harness the great power of PET imaging. Here, we reviewed some recent investigations with lipid-based small molecule PET radio-tracers with relevance to fasting, and discuss their potential in the diagnosis and staging of HCCs.


  1. Kostakoglu L, Agress H Jr, Goldsmith SJ, Clinical role of FDG PET in evaluation of cancer patients. Radiographics. 2003 Mar-Apr;23(2):315-40; quiz 533
  2. Lindholm P, Minn H, Leskinen-Kallio Bergman SJ, Ruotsalainen U, and Joensuu H, Influence of the blood glucose concentration on FDG uptake in cancer - a PET study, J Nucl Med, vol. 34, pp. 1-6, 1993.
  3. Lee KH, Ko BH, Paik JY, et al. Effects of anesthetic agents and fasting duration on 18F-FDG biodistribution and insulin levels in tumor-bearing mice. J Nucl Med 2005;46:1531-6.
  4. Okumura W, Iwasaki T, Toyama T, et al. Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. J Nucl Med 2004;45:1989-98
  5. Jeng LB, Changlai SP, Shen YY, Lin CC, Tsai CH, and Kao CH, Limited value of 18F-2-deoxyglucose positron emission tomography to detect hepatocellular carcinoma in hepatitis B virus carriers, Hepatogastroenterology, vol. 50, pp. 2154-6, 2003.
  6. Khan MA, Combs CS, Brunt EM, Lowe VJ, Wolverson MK, Solomon H, Collins BT, and Di Bisceglie AM, Positron emission tomography scanning in the evaluation of hepatocellular carcinoma, J Hepatol, vol. 32, pp. 792-7, 2000.
  7. Ho CL, Yu SC, Yeung DW. 11C-acetate PET imaging in hepatocellular carcinoma and other liver masses. J Nucl Med 2003;44:213-21.
  8. Talbot JN, Gutman F, Fartoux L, et al. PET/CT in patients with hepatocellular carcinoma using [(18)F]fluorocholine: preliminary comparison with [ (18)F]FDG PET/CT. Eur J Nucl Med Mol Imaging 2006;33:1285-9.
  9. Salem N, Kuang Y, Corn DJ, Erokwu B, Kolthammer JA, Tian H, Wu C, Wang F, Wang Y, Lee Z, [(Methyl)1-11C]-Acetate Metabolism in Hepatocellular Carcinoma, Molecular Imaging and Biology, 13:140-151, 2011.
  10. Kuang Y, Salem N, Tian H, Kolthammer JA, Corn DJ, Wu C, Wang F, Wang Y, Lee Z, Imaging Lipid Synthesis in Hepatocellular Carcinoma with [Methyl-11C]Choline Correlated with Metabolites Study in vivo, Journal of Nuclear Medicine, 52(1):98-106, 2011.
  11. Kolthammer JA, Corn DJ, Tenley N, et al. PET imaging of hepatocellular carcinoma with 18F-fluoroethylcholine and 11C-choline. Eur J Nucl Med Mol Imaging 2011;38:1248-56.
  12. Tenley N, Corn DJ, Yuan L, Wu C, Lee Z, The effect of fasting on PET Imaging of Hepatocellular Carcinoma, Journal of Cancer Therapy 2013, 4, 562-567.
  13. Hatzivassiliou G, Zhao F, Bauer DE, Andreadis C, Shaw AN, Dhanak D, Hingorani SR, Tuveson DA, and Thompson CB, ATP citrate lyase inhibition can suppress tumor cell growth, Cancer Cell, vol. 8, pp. 311-21, 2005.
  14. Alberts B, Johnson A, Lewis J, et al. Cell chemistry and biosynthesis. In: Molecular Biology of the Cell. 4th. New York: Garland Science; 2002:47-109.
  15. Elwood JC and Morris HP, Lack of adaptation in lipogenesis by hepatoma 9121, J Lipid Res, vol. 9, pp. 337-41, 1968.