Hepatosellüler Karsinom Tanısında F-18 FDG PET/BT ile Ga-68 PSMA PET/BT Çalışmaların Rolü

Yıl 2025, Cilt: 52 Sayı: 4, 845 - 852, 12.12.2025

Erdal Çetinkaya Fatih Güzel , Şadiye Altun Tuzcu , Bekir Taşdemir , İlbey Erkin Çetin Kendal Yalçın

https://doi.org/10.5798/dicletip.1841151

Öz

Amaç: Bu çalışmanın amacı, Flor-18 florodeoksiglukoz pozitron emisyon tomografi/bilgisayarlı tomografi (F-18 FDG PET/BT) ile Galyum-68 prostat spesifik membran antijeni (Ga-68 PSMA) PET/BT’den elde edilen parametreleri karşılaştırmak ve Ga-68 PSMA PET/BT’nin hepatoselüler karsinom (HCC) tanısı ve klinik yönetimine katkısını araştırmaktı.
Yöntemler: Manyetik rezonans görüntüleme (MRI), alfa-fetoprotein (AFP) değeri ve klinik bulgular ile HCC tanısı konulan 16 hastaya, hem F-18 FDG PET/BT, hem de Ga-68 PSMA PET/BT incelemesi yapıldı. Hastalar, karaciğerde saptanan primer kitleye ait görüntüleme bulgularına göre üç gruba ayrıldı: Grup 1 (F-18 FDG pozitif ve Ga-68 PSMA pozitif), Grup 2 (F-18 FDG negatif ve Ga-68 PSMA pozitif) ve Grup 3 (F-18 FDG negatif ve Ga-68 PSMA negatif). Ayrıca her hastanın AFP değerleri kaydedildi.
Bulgular: Çalışmaya toplam 16 hasta dâhil edildi. 16 hastanın 14’ünde (%87,5) Ga-68 PSMA PET/BT ile karaciğer tümörlerinde arka plan düzeyinin üzerinde aktivite tutulumu gözlendi. F-18 FDG PET/BT’de ise bu oran %75 (12 hasta) olarak bulundu. Tümör background oranı (TBR), FDG için ortalama 1.97 (±1.04), Ga-68 PSMA için ise ortalama 2.77 (±2.27) olarak saptandı. Ayrıca 6 hastada (%37,5) ekstrahepatik metastatik odaklarda da belirgin patolojik aktivite tutulumları tespit edildi.
Sonuç: Ga-68 PSMA PET/BT'nin, HCC hastalarında primer tümörlerin saptanmasında F-18 FDG PET/BT’ye kıyasla daha yüksek tanısal performans gösterdiği ortaya konmuştur. Bu bulgu, Ga-68 PSMA PET/BT’nin HCC’nin tanı ve evrelemesinde tamamlayıcı bir rol üstlenebileceğini düşündürmüştür.

Anahtar Kelimeler

F-18 FDG , Ga-68 PSMA , hepatoselüler karsinom , PET/BT

Etik Beyan

Bu çalışma Dicle Üniversitesi Tıp Fakültesi Nükleer Tıp Anabilim Dalı’nda gerçekleştirildi. Etik onay, Dicle Üniversitesi Klinik Araştırmalar Etik Kurulu’ndan alındı (IRB No ve tarih: 92/ 15.03.2023).

The Role of F-18 FDG PET/CT and Ga-68 PSMA PET/CT on the Diagnosis of Hepatocellular Carcinoma

Öz

Objective: The aim of this study was to compare the parameters obtained from fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) and gallium-68 prostate-specific membrane antigen (Ga-68 PSMA) PET/CT, and to investigate the potential contribution of Ga-68 PSMA PET/CT in the diagnosis and clinical management of hepatocellular carcinoma (HCC).
Methods: Both F-18 FDG PET/CT and Ga-68 PSMA PET/CT examinations were performed in 16 patients diagnosed with HCC based on Magnetic resonance imaging (MRI), alpha-fetoprotein (AFP) values and clinical findings. Patients were divided into three groups according to the imaging characteristics of the primary hepatic lesion: Group 1 (F-18 FDG positive and Ga-68 PSMA positive), Group 2 (F-18 FDG negative and Ga-68 PSMA positive), and Group 3 (F-18 FDG negative and Ga-68 PSMA negative). Additionally, AFP values of each patient were recorded.
Results: A total of 16 patients were included in the study. In 14 of 16 patients (87.5%), activity showed higher uptake than the surrounding tissue levels was observed in liver tumors with Ga-68 PSMA PET/CT. This rate was found to be 75% (12 patients) with F-18 FDG PET/CT. The mean tumor-to-background ratio (TBR) was 1.97 (±1.04) for FDG and 2.77 (±2.27) for Ga-68 PSMA. Additionally, significant pathological activity uptake was detected in extrahepatic metastatic foci in 6 patients (37.5%).
Conclusion: Ga-68 PSMA PET/CT demonstrated higher diagnostic performance than F-18 FDG PET/CT in detecting primary tumors in HCC patients. This finding suggests that Ga-68 PSMA PET/CT may play a complementary role in the diagnosis and staging of HCC.

Anahtar Kelimeler

F-18 FDG , Ga-68 PSMA , hepatocellular carcinoma , PET/CT.

Kaynakça

• 1.Bray F, Laversanne M, Sung H, et al. Global cancerstatistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63.
• 2.Rumgay H, Ferlay J, de Martel C, et al. Global,regional and national burden of primary liver cancerby subtype. Eur J Cancer. 2022;161:108-18.
• 3.London WT, Petrick JL, McGlynn KA. Liver cancer.In: Thun MJ, Linet MS, Cerhan JR, Haiman C,Schottenfeld D, editors. Cancer Epidemiology andPrevention. 4th ed. Oxford: Oxford University Press;2017. p. 635-60.
• 4.Qian GS, Ross RK, Yu MC, et al. Hepatitis C virusrelated cirrhosis: time to occurrence ofhepatocellular carcinoma and death. Gut.2000;47:131-6.
• 5.Brusset B, Jacquemin M, Teyssier Y, et al.Radiological diagnosis of hepatocellular carcinomadoes not preclude biopsy before treatment. JHEPRep. 2024;6(1):100957.
• 6.Yao Y, Civelek AC, Li XF. The application of 18F-FDG PET/CT imaging for human hepatocellularcarcinoma: a narrative review. Quant Imaging MedSurg. 2023;13(9):6268-79.
• 7.Lee YJ, Lee JM, Lee JS, et al. Hepatocellularcarcinoma: diagnostic performance of multidetectorCT and MR imaging–a systematic review and meta-analysis. Radiology. 2015;275:97-109.
• 8.Civelek AC, Piotrowski B, Osman MM, et al.Cutaneous metastatic lung cancer detected with18F-FDG PET. Ann Nucl Med. 2006;20:147-9.
• 9.Jeng LB, Changlai SP, Shen YY, et al. Limited valueof 18F-2-deoxyglucose positron emissiontomography to detect hepatocellular carcinoma inhepatitis B virus carriers. Hepatogastroenterology.2003;50(54):2154-6.
• 10.Combs CS, Brunt EM, Lowe VJ, et al. Positronemission tomography scanning in the evaluation ofhepatocellular carcinoma. J Hepatol. 2000;32:792-7.
• 11.Lu RC, She B, Gao WT, et al. Positron-emissiontomography for hepatocellular carcinoma: currentstatus and future prospects. World J Gastroenterol.2019;25:4682-95.
• 12.Hannah N, Yu C, Nedumannil L, et al. Prostate-specific membrane antigen (PSMA) PET/CT in thedetection and diagnosis of hepatocellular carcinoma (HCC): a systematic review and meta-analysis. Cancers. 2024;16(22):3865.
• 13.Maurer T, Eiber M, Schwaiger M, Gschwend JE.Current use of PSMA-PET in prostate cancermanagement. Nat Rev Urol. 2016;13:226-35.
• 14.Hofman MS, Lawrentschuk N, Francis RJ, et al.Prostate-specific membrane antigen PET-CT inpatients with high-risk prostate cancer beforecurative-intent surgery or radiotherapy (proPSMA):a prospective, randomised, multicentre study.Lancet. 2020;395:1208-16.
• 15.Huang HL, Zhen Loh TJ, Hoe Chow PK. A case ofwell-differentiated hepatocellular carcinomaidentified on gallium-68 prostate-specificmembrane antigen positron emissiontomography/computed tomography. World J NuclMed. 2018;17:102-5.
• 16.Denmeade SR, Mhaka AM, Rosen DM, et al.Prostate-specific membrane antigen-activatedtumor endothelial cell prodrug for cancer therapy.Sci Transl Med. 2012;4:140ra86.
• 17.Sasikumar A, Joy A, Nanabala R, Pillai MR,Thomas B, Vikraman KR. 68Ga-PSMA PET/CTimaging in primary hepatocellular carcinoma. Eur JNucl Med Mol Imaging. 2016;43:795-6.
• 18.Kesler M, Levine C, Hershkovitz D, et al. 68Ga-labeled prostate-specific membrane antigen is anovel PET/CT tracer for imaging of hepatocellularcarcinoma: a prospective pilot study. J Nucl Med.2019;60(2):185-91.
• 19.Kuyumcu S, Has-Simsek D, Iliaz R, et al. Evidenceof prostate-specific membrane antigen expressionin hepatocellular carcinoma using 68Ga-PSMAPET/CT. Clin Nucl Med. 2019;44(9):702-6.
• 20.Gündoğan C, Ergül N, Çakır MS, et al. 68Ga-PSMAPET/CT versus 18F-FDG PET/CT for imaging ofhepatocellular carcinoma. Mol Imaging RadionuclTher. 2021;30(2):79-85.
• 21.Ho CL, Chen S, Yeung DW, Cheng TK. Dual-tracerPET/CT imaging in evaluation of metastatichepatocellular carcinoma. J Nucl Med.2007;48(6):902-9.