Utility of [18F]FSPG PET to Image Hepatocellular Carcinoma: First Clinical Evaluation in a US Population

Purpose Non-invasive imaging is central to hepatocellular carcinoma (HCC) diagnosis; however, conventional modalities are limited by smaller tumors and other chronic diseases that are often present in patients with HCC, such as cirrhosis. This pilot study evaluated the feasibility of (4 S )-4-(3-[ 1...

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Veröffentlicht in:Molecular imaging and biology 2016-12, Vol.18 (6), p.924-934
Hauptverfasser: Kavanaugh, Gina, Williams, Jason, Morris, Andrew Scott, Nickels, Michael L., Walker, Ronald, Koglin, Norman, Stephens, Andrew W., Washington, M. Kay, Geevarghese, Sunil K., Liu, Qi, Ayers, Dan, Shyr, Yu, Manning, H. Charles
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container_end_page 934
container_issue 6
container_start_page 924
container_title Molecular imaging and biology
container_volume 18
creator Kavanaugh, Gina
Williams, Jason
Morris, Andrew Scott
Nickels, Michael L.
Walker, Ronald
Koglin, Norman
Stephens, Andrew W.
Washington, M. Kay
Geevarghese, Sunil K.
Liu, Qi
Ayers, Dan
Shyr, Yu
Manning, H. Charles
description Purpose Non-invasive imaging is central to hepatocellular carcinoma (HCC) diagnosis; however, conventional modalities are limited by smaller tumors and other chronic diseases that are often present in patients with HCC, such as cirrhosis. This pilot study evaluated the feasibility of (4 S )-4-(3-[ 18 F]fluoropropyl)-L-glutamic acid ([ 18 F]FSPG) positron emission tomography (PET)/X-ray computed tomography (CT) to image HCC. [ 18 F]FSPG PET/CT was compared to standard-of-care (SOC) magnetic resonance imaging (MRI) and CT, and [ 11 C]acetate PET/CT, commonly used in this setting. We report the largest cohort of HCC patients imaged to date with [ 18 F]FSPG PET/CT and present the first comparison to [ 11 C]acetate PET/CT and SOC imaging. This study represents the first in a US HCC population, which is distinguished by different underlying comorbidities than non-US populations. Procedures x C− transporter RNA and protein levels were evaluated in HCC and matched liver samples from The Cancer Genome Atlas ( n  = 16) and a tissue microarray ( n  = 83). Eleven HCC patients who underwent prior MRI or CT scans were imaged by [ 18 F]FSPG PET/CT, with seven patients also imaged with [ 11 C]acetate PET/CT. Results x C− transporter RNA and protein levels were elevated in HCC samples compared to background liver. Over 50 % of low-grade HCCs and ~70 % of high-grade tumors exceeded background liver protein expression. [ 18 F]FSPG PET/CT demonstrated a detection rate of 75 %. [ 18 F]FSPG PET/CT also identified an HCC devoid of typical MRI enhancement pattern. Patients scanned with [ 18 F]FSPG and [ 11 C]acetate PET/CT exhibited a 90 and 70 % detection rate, respectively. In dually positive tumors, [ 18 F]FSPG accumulation consistently resulted in significantly greater tumor-to-liver background ratios compared with [ 11 C]acetate PET/CT. Conclusions [ 18 F]FSPG PET/CT is a promising modality for HCC imaging, and larger studies are warranted to examine [ 18 F]FSPG PET/CT impact on diagnosis and management of HCC. [ 18 F]FSPG PET/CT may also be useful for phenotyping HCC tumor metabolism as part of precision cancer medicine.
doi_str_mv 10.1007/s11307-016-1007-0
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We report the largest cohort of HCC patients imaged to date with [ 18 F]FSPG PET/CT and present the first comparison to [ 11 C]acetate PET/CT and SOC imaging. This study represents the first in a US HCC population, which is distinguished by different underlying comorbidities than non-US populations. Procedures x C− transporter RNA and protein levels were evaluated in HCC and matched liver samples from The Cancer Genome Atlas ( n  = 16) and a tissue microarray ( n  = 83). Eleven HCC patients who underwent prior MRI or CT scans were imaged by [ 18 F]FSPG PET/CT, with seven patients also imaged with [ 11 C]acetate PET/CT. Results x C− transporter RNA and protein levels were elevated in HCC samples compared to background liver. Over 50 % of low-grade HCCs and ~70 % of high-grade tumors exceeded background liver protein expression. [ 18 F]FSPG PET/CT demonstrated a detection rate of 75 %. [ 18 F]FSPG PET/CT also identified an HCC devoid of typical MRI enhancement pattern. Patients scanned with [ 18 F]FSPG and [ 11 C]acetate PET/CT exhibited a 90 and 70 % detection rate, respectively. In dually positive tumors, [ 18 F]FSPG accumulation consistently resulted in significantly greater tumor-to-liver background ratios compared with [ 11 C]acetate PET/CT. Conclusions [ 18 F]FSPG PET/CT is a promising modality for HCC imaging, and larger studies are warranted to examine [ 18 F]FSPG PET/CT impact on diagnosis and management of HCC. [ 18 F]FSPG PET/CT may also be useful for phenotyping HCC tumor metabolism as part of precision cancer medicine.</description><identifier>ISSN: 1536-1632</identifier><identifier>EISSN: 1860-2002</identifier><identifier>DOI: 10.1007/s11307-016-1007-0</identifier><identifier>PMID: 27677886</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Acetates - chemistry ; Adult ; Aged ; Amino Acid Transport System y+ - genetics ; Amino Acid Transport System y+ - metabolism ; Carbon Radioisotopes ; Carcinoma, Hepatocellular - diagnostic imaging ; Carcinoma, Hepatocellular - genetics ; Carcinoma, Hepatocellular - pathology ; Female ; Glutamates - chemistry ; Glutamic Acid - chemistry ; Humans ; Imaging ; Liver Neoplasms - diagnostic imaging ; Liver Neoplasms - genetics ; Liver Neoplasms - pathology ; Male ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Positron-Emission Tomography - methods ; Radiology ; Radiopharmaceuticals - chemistry ; Research Article ; Sequence Analysis, RNA ; Tissue Array Analysis</subject><ispartof>Molecular imaging and biology, 2016-12, Vol.18 (6), p.924-934</ispartof><rights>World Molecular Imaging Society 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c503t-841276c9ce2b001dd83c44bae64c8c1314530d9491cdde65fab46db2330b5c5a3</citedby><cites>FETCH-LOGICAL-c503t-841276c9ce2b001dd83c44bae64c8c1314530d9491cdde65fab46db2330b5c5a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11307-016-1007-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11307-016-1007-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27677886$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kavanaugh, Gina</creatorcontrib><creatorcontrib>Williams, Jason</creatorcontrib><creatorcontrib>Morris, Andrew Scott</creatorcontrib><creatorcontrib>Nickels, Michael L.</creatorcontrib><creatorcontrib>Walker, Ronald</creatorcontrib><creatorcontrib>Koglin, Norman</creatorcontrib><creatorcontrib>Stephens, Andrew W.</creatorcontrib><creatorcontrib>Washington, M. Kay</creatorcontrib><creatorcontrib>Geevarghese, Sunil K.</creatorcontrib><creatorcontrib>Liu, Qi</creatorcontrib><creatorcontrib>Ayers, Dan</creatorcontrib><creatorcontrib>Shyr, Yu</creatorcontrib><creatorcontrib>Manning, H. Charles</creatorcontrib><title>Utility of [18F]FSPG PET to Image Hepatocellular Carcinoma: First Clinical Evaluation in a US Population</title><title>Molecular imaging and biology</title><addtitle>Mol Imaging Biol</addtitle><addtitle>Mol Imaging Biol</addtitle><description>Purpose Non-invasive imaging is central to hepatocellular carcinoma (HCC) diagnosis; however, conventional modalities are limited by smaller tumors and other chronic diseases that are often present in patients with HCC, such as cirrhosis. This pilot study evaluated the feasibility of (4 S )-4-(3-[ 18 F]fluoropropyl)-L-glutamic acid ([ 18 F]FSPG) positron emission tomography (PET)/X-ray computed tomography (CT) to image HCC. [ 18 F]FSPG PET/CT was compared to standard-of-care (SOC) magnetic resonance imaging (MRI) and CT, and [ 11 C]acetate PET/CT, commonly used in this setting. We report the largest cohort of HCC patients imaged to date with [ 18 F]FSPG PET/CT and present the first comparison to [ 11 C]acetate PET/CT and SOC imaging. This study represents the first in a US HCC population, which is distinguished by different underlying comorbidities than non-US populations. Procedures x C− transporter RNA and protein levels were evaluated in HCC and matched liver samples from The Cancer Genome Atlas ( n  = 16) and a tissue microarray ( n  = 83). Eleven HCC patients who underwent prior MRI or CT scans were imaged by [ 18 F]FSPG PET/CT, with seven patients also imaged with [ 11 C]acetate PET/CT. Results x C− transporter RNA and protein levels were elevated in HCC samples compared to background liver. Over 50 % of low-grade HCCs and ~70 % of high-grade tumors exceeded background liver protein expression. [ 18 F]FSPG PET/CT demonstrated a detection rate of 75 %. [ 18 F]FSPG PET/CT also identified an HCC devoid of typical MRI enhancement pattern. Patients scanned with [ 18 F]FSPG and [ 11 C]acetate PET/CT exhibited a 90 and 70 % detection rate, respectively. In dually positive tumors, [ 18 F]FSPG accumulation consistently resulted in significantly greater tumor-to-liver background ratios compared with [ 11 C]acetate PET/CT. Conclusions [ 18 F]FSPG PET/CT is a promising modality for HCC imaging, and larger studies are warranted to examine [ 18 F]FSPG PET/CT impact on diagnosis and management of HCC. 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Kay</au><au>Geevarghese, Sunil K.</au><au>Liu, Qi</au><au>Ayers, Dan</au><au>Shyr, Yu</au><au>Manning, H. Charles</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Utility of [18F]FSPG PET to Image Hepatocellular Carcinoma: First Clinical Evaluation in a US Population</atitle><jtitle>Molecular imaging and biology</jtitle><stitle>Mol Imaging Biol</stitle><addtitle>Mol Imaging Biol</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>18</volume><issue>6</issue><spage>924</spage><epage>934</epage><pages>924-934</pages><issn>1536-1632</issn><eissn>1860-2002</eissn><abstract>Purpose Non-invasive imaging is central to hepatocellular carcinoma (HCC) diagnosis; however, conventional modalities are limited by smaller tumors and other chronic diseases that are often present in patients with HCC, such as cirrhosis. This pilot study evaluated the feasibility of (4 S )-4-(3-[ 18 F]fluoropropyl)-L-glutamic acid ([ 18 F]FSPG) positron emission tomography (PET)/X-ray computed tomography (CT) to image HCC. [ 18 F]FSPG PET/CT was compared to standard-of-care (SOC) magnetic resonance imaging (MRI) and CT, and [ 11 C]acetate PET/CT, commonly used in this setting. We report the largest cohort of HCC patients imaged to date with [ 18 F]FSPG PET/CT and present the first comparison to [ 11 C]acetate PET/CT and SOC imaging. This study represents the first in a US HCC population, which is distinguished by different underlying comorbidities than non-US populations. Procedures x C− transporter RNA and protein levels were evaluated in HCC and matched liver samples from The Cancer Genome Atlas ( n  = 16) and a tissue microarray ( n  = 83). Eleven HCC patients who underwent prior MRI or CT scans were imaged by [ 18 F]FSPG PET/CT, with seven patients also imaged with [ 11 C]acetate PET/CT. Results x C− transporter RNA and protein levels were elevated in HCC samples compared to background liver. Over 50 % of low-grade HCCs and ~70 % of high-grade tumors exceeded background liver protein expression. [ 18 F]FSPG PET/CT demonstrated a detection rate of 75 %. [ 18 F]FSPG PET/CT also identified an HCC devoid of typical MRI enhancement pattern. Patients scanned with [ 18 F]FSPG and [ 11 C]acetate PET/CT exhibited a 90 and 70 % detection rate, respectively. In dually positive tumors, [ 18 F]FSPG accumulation consistently resulted in significantly greater tumor-to-liver background ratios compared with [ 11 C]acetate PET/CT. Conclusions [ 18 F]FSPG PET/CT is a promising modality for HCC imaging, and larger studies are warranted to examine [ 18 F]FSPG PET/CT impact on diagnosis and management of HCC. [ 18 F]FSPG PET/CT may also be useful for phenotyping HCC tumor metabolism as part of precision cancer medicine.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27677886</pmid><doi>10.1007/s11307-016-1007-0</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record>
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subjects Acetates - chemistry
Adult
Aged
Amino Acid Transport System y+ - genetics
Amino Acid Transport System y+ - metabolism
Carbon Radioisotopes
Carcinoma, Hepatocellular - diagnostic imaging
Carcinoma, Hepatocellular - genetics
Carcinoma, Hepatocellular - pathology
Female
Glutamates - chemistry
Glutamic Acid - chemistry
Humans
Imaging
Liver Neoplasms - diagnostic imaging
Liver Neoplasms - genetics
Liver Neoplasms - pathology
Male
Medicine
Medicine & Public Health
Middle Aged
Positron-Emission Tomography - methods
Radiology
Radiopharmaceuticals - chemistry
Research Article
Sequence Analysis, RNA
Tissue Array Analysis
title Utility of [18F]FSPG PET to Image Hepatocellular Carcinoma: First Clinical Evaluation in a US Population
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