Qualitative and Quantitative Differentiation Efficiency of Dual-Tracer Pet/Ct With 18F-Fluorodeoxyglucose and 11C-Acetate for Primary Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis Publisher Pubmed



Mohebbi A^{1, 2} ; Kiani I^{1, 2} ; Mohammadzadeh S^{1, 2} ; Mohammadi A³ ; Tavangar SM^{4, 5} Show Affiliations
Source: Abdominal Radiology Published:2025

Abstract

Purpose: Primary hepatocellular carcinoma (HCC) represents a substantial global health challenge. Early diagnosis of HCC is crucial for improved patient outcomes. The aim of this study was to assess qualitative and quantitative diagnostic performance of PET/CT using 11C-acetate and [18F]-fluorodeoxyglucose (FDG) in detection of primary HCC and to determine if 11C-acetate added to [18F]-FDG alleviates the low sensitivity rate mentioned in guidelines. Methods: Protocol was pre-registered at https://osf.io/2vcb9. We searched PubMed, Web of Science, Embase, and the Cochrane Library for included studies. Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the risk of bias. Possible sources of statistical heterogeneity were explored. Additionally, mentioned three PET/CT tests were evaluated for their diagnostic performance in differentiating HCC from its differential diagnoses. Grades of Recommendation, Assessment, Development, and Evaluation was used to assess quality of generated evidence. Results: Twenty-four studies were analyzed. Qualitative dual-tracer PET/CT demonstrated 92.0% per-lesion sensitivity, and a significantly higher direct sensitivity difference of 30% to conventional CT, 44.7% to [18F]-FDG, and 12.0% to 11C-acetate. Regarding differentiation rate, [18F]-FDG was superior to 11C-acetate in poorly differentiated lesions while 11C-acetate was superior in well-differentiated lesions. Regarding size, dual tracer combination solved the high missing rate of HCC lesions in 1–2 cm and 2–5 cm groups but could not help in size < 1 cm. Conclusion: Dual-tracer PET/CT utilizing 11C-acetate and [18F]-FDG represents a sensitive method for detecting primary HCC. By concurrently quantifying or qualifying the uptake of 11C-acetate and [18F]-FDG, this multimodal approach enables precise localization of intrahepatic lesions. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.