Dual-tracer PET/CT Scan and Liver Transplants

The success rate of liver transplants for patients with HCC improves when patient selection is based, in part, on the so-called Milan criteria. The liver transplant patients selection criteria are traditionally assessed by contrast CT and MRI, which is known to be affected by structural or architectural changes in cirrhotic livers.

Dr. Tan To Cheung and colleagues from the department of surgery at Queen Mary Hospital and the University of Hong Kong had compare the imaging data of dual-tracer PET/CT and contrast CT with data from postoperative pathologic analysis for accuracy in assessment of parameters specified by the Milan criteria (tumor size and extent, vascular invasion, and metastasis), TNM staging, and patient selection for transplant.

According to the researchers data the overall sensitivity (97%) and specificity (92%) for dual-tracer PET/CT for patient selection for liver transplantation were significantly greater than those of contrast-enhanced CT, at 42% and 33%, respectively.

The lower results with contrast-enhanced CT were related to cirrhosis or previous treatment, which can hamper the differentiation of cirrhotic nodules from HCC lesions and the estimation of tumor size, Cheung and colleagues noted.

“Dual-tracer PET/CT was significantly less affected by cirrhotic changes than contrast-enhanced CT for HCC staging and patient selection for liver transplantation on the basis of the Milan criteria,” Dr. Cheung .

Dual-tracer PET/CT is more effective than contrast-enhanced CT for hepatocellular carcinoma (HCC) staging and may warrant “serious consideration” for use in determining which patients could benefit the most from a liver transplant.