Utility of [18F]FSPG PET to Image Hepatocellular Carcinoma: First Clinical Evaluation in a US Population |
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Authors: | Gina Kavanaugh,Jason Williams,Andrew Scott Morris,Michael L. Nickels,Ronald Walker,Norman Koglin,Andrew W. Stephens,M. Kay Washington,Sunil K. Geevarghese,Qi Liu,Dan Ayers,Yu Shyr,H. Charles Manning |
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Affiliation: | 1.Vanderbilt University Institute of Imaging Science,Vanderbilt University Medical Center,Nashville,USA;2.Department of Radiology and Radiological Sciences,Vanderbilt University Medical Center,Nashville,USA;3.Vanderbilt Center for Molecular Probes,Vanderbilt University Medical Center,Nashville,USA;4.Vanderbilt-Ingram Cancer Center,Vanderbilt University Medical Center,Nashville,USA;5.Piramal Imaging GmbH,Berlin,Germany;6.Department of Pathology,Vanderbilt University Medical Center,Nashville,USA;7.Department of Surgery,Vanderbilt University Medical Center,Nashville,USA;8.Department of Biomedical Informatics,Vanderbilt University School of Medicine,Nashville,USA;9.Center for Quantitative Sciences,Vanderbilt University School of Medicine,Nashville,USA;10.Department of Biostatistics,Vanderbilt University School of Medicine,Nashville,USA;11.Department of Cancer Biology,Vanderbilt University School of Medicine,Nashville,USA;12.Program in Chemical and Physical Biology,Vanderbilt University Medical Center,Nashville,USA;13.Department of Neurosurgery,Vanderbilt University Medical Center,Nashville,USA;14.Vanderbilt Institute of Chemical Biology,Vanderbilt University Medical Center,Nashville,USA;15.Department of Biomedical Engineering,Vanderbilt University,Nashville,USA;16.Department of Chemistry,Vanderbilt University,Nashville,USA |
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Abstract: | PurposeNon-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 (4S)-4-(3-[18F]fluoropropyl)-L-glutamic acid ([18F]FSPG) positron emission tomography (PET)/X-ray computed tomography (CT) to image HCC. [18F]FSPG PET/CT was compared to standard-of-care (SOC) magnetic resonance imaging (MRI) and CT, and [11C]acetate PET/CT, commonly used in this setting. We report the largest cohort of HCC patients imaged to date with [18F]FSPG PET/CT and present the first comparison to [11C]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.ProceduresxC? 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 [18F]FSPG PET/CT, with seven patients also imaged with [11C]acetate PET/CT.ResultsxC? 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. [18F]FSPG PET/CT demonstrated a detection rate of 75 %. [18F]FSPG PET/CT also identified an HCC devoid of typical MRI enhancement pattern. Patients scanned with [18F]FSPG and [11C]acetate PET/CT exhibited a 90 and 70 % detection rate, respectively. In dually positive tumors, [18F]FSPG accumulation consistently resulted in significantly greater tumor-to-liver background ratios compared with [11C]acetate PET/CT.Conclusions[18F]FSPG PET/CT is a promising modality for HCC imaging, and larger studies are warranted to examine [18F]FSPG PET/CT impact on diagnosis and management of HCC. [18F]FSPG PET/CT may also be useful for phenotyping HCC tumor metabolism as part of precision cancer medicine. |
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