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11C-acetate: a new tracer for the evaluation of hepatocellular carcinoma.

Hepatocellular carcinomas (HCCs) arise from the malignant transformation of hepatocytes and are a common risk factor in the setting of chronic liver disease such as viral hepatitis or cirrhosis or in patients exposed to carcinogens. HCC has been a relatively uncommon malignancy in the United States but is being seen with increasing frequency associated with the marked increase in hepatitis C infection. HCC represents the predominant type of primary liver cancer and is associated with chronic liver disease and underlying cirrhosis in 70% of patients (1). HCC most frequently metastasizes to regional lymph nodes, lung, and bone. Because the majority of patients present with advanced-stage malignancy and associated cirrhosis, treatment options remain limited. Even in patients who are able to undergo successful curative resection, up to 50% will develop intrahepatic recurrence from second primaries or from intrahepatic spread. The diagnostic issues of conventional imaging include early detection of these tumors, differentiation from regenerative nodules and other benign liver tumors, accurate tumor staging, and assessment of the response to therapy. Evaluation and screening for hepatic lesions is commonly performed with transabdominal ultrasonography, CT, or MRI. Ultrasonography can detect lesions as small as 1 cm in diameter but is operator dependent, is inherently 2-dimensional, and suffers from poor specificity. CT and MRI have been the conventional method for screening the liver at many institutions in the United States. Although tomographic imaging studies (CT and MRI) have been the mainstay for diagnosis and staging of HCC, attempts to improve staging and follow-up of patients with known HCC have led to the evaluation of molecular imaging in HCC.