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Primary Hepatocellular Carcinoma With Intense 68Ga-PSMA Uptake But Slight 18F-FDG Uptake on PET/CT Imaging

Authors:
Seval Erhamamcı at Baskent University
Seval Erhamamcı
Nesrin Aslan
Nesrin Aslan
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Abstract

Ga-PSMA PET/CT imaging is an emerging imaging modality in prostate cancer. PSMA expression is also reported for nonprostate malignancies, including primary hepatocellular carcinoma. Herein, we present a case of a 74-year-ald man with recently diagnosed hepatocellular carcinoma who was referred for F-FDG PET/CT imaging for initial staging. The patient underwent F-FDG PET/CT as part of staging procedure; he also underwent Ga-PSMA PET/CT. PET/CT images revealed only slight F-FDG uptake in the liver lesion, but intense Ga-PSMA uptake, without any metastatic lesion seen elsewhere in the body.
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Primary Hepatocellular Carcinoma With Intense
68
Ga-PSMA
Uptake But Slight
18
F-FDG Uptake on PET/CT Imaging
Seval Erhamamcı, MD,* and Nesrin Aslan, MD†
Abstract:
68
Ga-PSMA PET/CT imaging is an emerging imaging modality
in prostate cancer. PSMA expression is also reported for nonprostate malig-
nancies, including primary hepatocellular carcinoma. Herein, we present a
case of a 74-year-ald manwith recently diagnosed hepatocellular carcinoma
who was referred for
18
F-FDG PET/CT imaging for initial staging. The pa-
tient underwent
18
F-FDG PET/CT as part of staging procedure; he also
underwent
68
Ga-PSMA PET/CT. PET/CT images revealed only slight
18
F-FDG uptake in the liver lesion, but intense
68
Ga-PSMA uptake, without
any metastatic lesion seen elsewhere in the body.
Key Words:
18
F-FDG,
68
Ga-PSMA, PET/CT, hepatocellular carcinoma
(Clin Nucl Med 2020;45: e176–e177)
REFERENCES
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W260–W265.
2. Afshar-Oromieh A, Avtzi E, Giesel FL, et al. The diagnostic value of PET/CT
imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of
recurrent prostate cancer. Eur J Nucl Med Mol Imaging.2015;42:197–209.
3. Huang HL, Zhen Loh TJ, Hoe Chow PK. A case of well-differentiated hepa-
tocellular carcinoma identified on gallium-68 prostate-specific membrane an-
tigen positron emission tomography/computed tomography. Wor ld J Nu c l
Med. 2018;17:102–105.
4. Perez PM, Flavell RR, Kelley RK, et al. Heterogeneous uptake of
18
F-FDG
and
68
Ga-PSMA-11 in hepatocellular carcinoma. Clin Nucl Med. 2019;44:
e133–e135.
5. Taneja S, Taneja R, Kashyap V, et al.
68
Ga-PSMA uptake in hepatocellular
carcinoma. Clin Nucl Med. 2017;42:e69–e70.
6. Sasikumar A, Joy A, Nanabala R, et al.
68
Ga-PSMA PET/CT imaging in pri-
mary hepatocellular carcinoma. Eur J Nucl Med Mol Imaging. 2016;43:
795–796.
7. Kesler M, Levine C, Hershkovitz D, et al.
68
Ga-PSMA is a novel PET-CT
tracer for imaging of hepatocellular carcinoma: a prospective pilot study.
JNuclMed. 2018. pii: jnumed.118.214833.
8. Kuyumcu S, Has-Simsek D, Iliaz R, et al. Evidence of prostate-specific mem-
brane antigen expression in hepatocellular carcinoma using
68
Ga-PSMA PET/
CT. Clin Nucl Med. 2019;44:702–706.
Received for publication October 21,2019; revision accepted November 9, 2019.
From the *Department of Nuclear Medicine, Baskent University Faculty of
Medicine; and †Department of Nuclear Medicine, Neolife Medical Center,
Istanbul, Turkey.
Conflicts of interest and sources of funding: none declared.
Correspondence to: Seval Erhamamcı, MD, Department of Nuclear Medicine,
Baskent University Istanbul Hospital, OymacıSok, No. 7, 34662 Altunizade,
İstanbul, Turkey. E-mail: sevaler@yahoo.com.
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0363-9762/20/4503–e176
DOI: 10.1097/RLU.0000000000002922
INTERESTING IMAGE
e176 www.nuclearmed.com Clinical Nuclear Medicine •Volume 45, Number 3, March 2020
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
FIGURE 1. A 74-year-old man was admitted for investigation of right side pain, weight loss, and pruritus. CT imaging of the
abdominal revealed a large space-occupying lesion of the liver. The α-fetoprotein level of the patient was elevated
(>20,000 ng/mL). He underwent a biopsy of the liver lesion, which revealed primary hepatocellular carcinoma (HCC) on
histopathological evaluation. The patient was referred for
18
F-FDG PET/CT imaging for initial staging.
18
F-FDG PET/CT MIP (A),
transaxial PET (B), transaxial CT (C), and transaxial fused (D) images revealed a malign gross tumoral lesion, covering almost all of
the right lobe of the liver and a large part of the left lobe medial segment, showing only slight
18
F-FDG uptake (SUV
max
,7.6),
with heterogeneus character, without any metastatic lesion seen elsewhere in the body. We performed
68
Ga-PSMA PET/CT scan
as an alternative staging modality and also to explore the possibility of PSMA-based therapy as a future option.
68
Ga-PSMA
PET/CT MIP (E), transaxial PET (F), transaxial CT (G), and transaxial fused (H) images demonstrated intense PSMA uptake
(SUV
max
, 20.3) in the gross tumoral lesion. There was no other finding to suggest metastatic disease. PSMA uptake is typically
more intense than FDG in the tumoral lesion. PET using
18
F-FDG has a limited role in evaluatingpatients with HCC due to factors
such as low metabolism, physiological liver activity, and false-positive findings.
168
Ga-PSMA PET/CT imaging was introduced
for the imaging of patients with high-risk prostate cancer at diagnosis and patients with biochemical failure after treatment.
2
However, PSMA has been shown to be overexpressed in the neovasculature of different nonprostate tumors, including
HCC.
3–868
Ga-PSMA uptake in HCC has been reported in a few cases and only 2 studies recently.
3–8
Kesler et al
7
reported that
68
Ga-PSMA PET/CT is superior to
18
F-FDG PET/CT for imaging patients with HCC. However, Kuyumcu et al
8
reported that
PSMA expression in advanced HCC can be demonstrated by
68
Ga-PSMA PET but is not superior to FDG PET. In the present case,
PSMA uptake is typically more intense than FDG in the tumoral lesion.
68
Ga-PSMA PET/CT could be a potential alternative
modality in HCC patients to improve staging sensitivity and to guide the choice of specific treatments. The presence of PSMA
expression could be an indicator for PSMA-based therapy, thus opening the way for an alternative therapeutic strategy in HCC
patients with limited therapeutic options.
Clinical Nuclear Medicine •Volume 45, Number 3, March 2020 PET/CT Imaging of Hepatocellular Carcinoma
© 2020 Wolters Kluwer Health, Inc. All rights reserved. www.nuclearmed.com e177
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
... A total of 55 articles were extrapolated with the computer literature search and by reviewing the titles and abstracts 43 of them were excluded because the reported data were not within the field of interest of this review. Twelve articles were selected and retrieved in full-text version [22][23][24][25][26][27][28][29][30][31][32][33]; one additional study was found screening the references of these articles [34]. A total of 13 articles were then included in the systematic review [22][23][24][25][26][27][28][29][30][31][32][33][34] (Fig. 1). ...
... Twelve articles were selected and retrieved in full-text version [22][23][24][25][26][27][28][29][30][31][32][33]; one additional study was found screening the references of these articles [34]. A total of 13 articles were then included in the systematic review [22][23][24][25][26][27][28][29][30][31][32][33][34] (Fig. 1). ...
... The majority of HCC shows high levels of PSMA expression on tumor vessels and on canalicular membrane of cells [26,28] and therefore important implications for PSMAtargeted imaging and therapy arise. PSMA-targeted imaging of HCC in clinical practice has been evaluated only by a few studies and most of these studies are case reports [22,23,[27][28][29][30][31][32][33][34], probably because of the small number of centers that currently use radiolabelled PSMA PET/CT or PET/ MRI, resulting in a reduction of the population of patients overall studied. ...
Radiolabelled PSMA PET/CT or PET/MRI in hepatocellular carcinoma (HCC): a systematic review
Article
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  • Oct 2020
Introduction Radiolabelled prostate-specific membrane antigen PSMA-based PET/CT or PET/MRI is a whole-body imaging technique usually performed for the detection of prostate cancer lesions. PSMA has been also demonstrated to be expressed by the neovasculature of many other solid tumors. The aim of this review is to evaluate the possible diagnostic role of radiolabelled PSMA PET/CT or PET/MRI in patients with hepatocellular carcinoma, by summarizing the available literature data. Methods A wide literature search of the PubMed/MEDLINE, Scopus, Embase and Cochrane library databases was made to find relevant published articles about the diagnostic performance of radiolabelled PSMA binding agents in PET/CT or PET/MRI imaging of patients with hepatocellular carcinoma. Results Ten case reports and three studies showed that hepatocellular carcinoma is PSMA-avid. Conclusion Radiolabelled PSMA imaging seems to be useful in analyzing hepatocellular carcinoma. Further studies enrolling a wider population are needed to clarify the real clinical and diagnostic role of radiolabelled PSMA in this setting.
View
... 68 Ga-PSMA PET/CT is a new diagnostic technique to image recurrent prostate cancer (2). However, increased PSMA expression has been reported for different non-prostate malignancies, including HCC (3,4,5,6,7,8). There are only a few published documents on the merits of PSMA-PET for HCC (3,4,5,6,7,8). ...
... However, increased PSMA expression has been reported for different non-prostate malignancies, including HCC (3,4,5,6,7,8). There are only a few published documents on the merits of PSMA-PET for HCC (3,4,5,6,7,8). In fact, a few case reports and only 2 studies involving a small sample size has been reported in the recent past. ...
View
... 68 Ga-PSMA PET/CT is a new diagnostic technique to image recurrent prostate cancer (2). However, increased PSMA expression has been reported for different non-prostate malignancies, including HCC (3,4,5,6,7,8). There are only a few published documents on the merits of PSMA-PET for HCC (3,4,5,6,7,8). ...
... However, increased PSMA expression has been reported for different non-prostate malignancies, including HCC (3,4,5,6,7,8). There are only a few published documents on the merits of PSMA-PET for HCC (3,4,5,6,7,8). In fact, a few case reports and only 2 studies involving a small sample size has been reported in the recent past. ...
Comparative Findings Between 68Ga-PSMA and 18F-FDG PET/CT for Hepatocellular Carcinoma
Article
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  • Oct 2020
We have reported here the case of a 69-year-old man who presented with spinal cord compression due to bone metastases as the first manifestation of hepatocellular carcinoma (HCC). For the initial staging, the patient underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) imaging, which demonstrated mild 18F-FDG uptake in the multiple expansile osteolytic bone lesions, but no remarkable atypical 18F-FDG uptake in the liver lesion on low-doses CT. An additional PET/CT scan was performed to evaluate the prostate-specific membrane antigen (PSMA) expression, which has recently been reported to be a potential biological marker in a variety of tumors including HCC. High PSMA uptake was recorded in both the metastatic bone lesions and the primary liver lesion/tumor by the 68Ga-PSMA PET/CT.
View
... Both of these imaging modalities were superior to multiphasic contrast-enhanced computed tomography [8]. Moreover, compared to F-18-Fluorodeoxy Glucose (FDG) PET/CT, PSMA PET/CT demonstrates superiority in the detection and staging of HCC [7,9,10]. Finally, PSMA PET/CT importance in detecting HCC was also linked to a change in treatment in roughly 50% of the patient population, indicating its high impact on management of HCC [7]. ...
View
... The images displayed low uptake of 18 F-FDG in the liver lesion, but great 68 Ga-PSMA uptake. No metastatic lesion was observed in the other tissues (Erhamamci & Aslan, 2020). ...
The Utility of Radiolabeled PSMA Ligands for Tumor Imaging
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  • Sep 2021
Prostate-specific membrane antigen (PSMA) is a glycosylated type-II transmembrane protein expressed in prostatic tissue and significantly overexpressed in several prostate cancer cells. Despite its name, PSMA has also been reported to be overexpressed in endothelial cells of benign and malignant non-prostate disease. So its clinical use was extended to detection, staging and therapy of various tumor types. Recently small molecules targeting PSMA have been developed as imaging probes for diagnosis of several malignancies. Preliminary studies are emerging improved diagnostic sensitivity and specificity of PSMA imaging, leading to a change in patient management. In this review we evaluated the first preclinical and clinical studies on PSMA ligands resulting future perspectives radiolabeled PSMA in staging and molecular characterization, based on histopathologic examinations of PSMA expression.
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Intrahepatic cholangiocarcinoma detected on F-PSMA-1007 PET/MR imaging in a prostate cancer patient: a case report and literature review
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Radionuclide probes-targeted prostate-specific membrane antigen (PSMA) is used in diagnosis and treatment of prostate cancer (PCa). Recent studies have shown that PSMA is expressed in the tumor neovascular endothelium, such as in malignant liver tumors. We report a case of PCa with incidental intrahepatic cholangiocarcinoma (ICC) detection using ¹⁸F-PSMA-1007 and ¹⁸F-fluorodeoxyglucose (FDG) positron emission topography (PET)/MRI.¹⁸F-PSMA-1007 PET/MRI of our patient with PCa showed that one liver lesion had high PSMA uptake. ¹⁸F-FDG PET/MRI revealed minimal FDG uptake in the liver lesion. Histopathological examination revealed that the liver lesion was moderately to poorly differentiated cholangiocarcinoma. Our studies, along with others, demonstrated that malignant liver tumors, such as ICC, hepatocellular carcinoma (HCC), and combined hepatocellular-cholangiocarcinoma (CHC), and benign lesions, such as benign liver hemangioma, focal nodular hyperplasia, focal inflammation and steatosis, vascular malformation, and fatty sparing, exhibited elevated PSMA uptake. Moreover, PSMA-PET was superior to FDG-PET in detecting ICC and HCC, indicating that PSMA-PET may be used as alternative staging and to identify patients for PSMA-targeted therapy.
View
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PSMA radioligand therapy for solid tumors other than prostate cancer: background, opportunities, challenges, and first clinical reports
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  • EUR J NUCL MED MOL I
In the past decade, a growing body of literature has reported promising results for prostate-specific membrane antigen (PSMA)-targeted radionuclide imaging and therapy in prostate cancer. First clinical studies evaluating the efficacy of [ ¹⁷⁷ Lu]Lu-PSMA radioligand therapy (PSMA-RLT) demonstrated favorable results in prostate cancer patients. [ ¹⁷⁷ Lu]Lu-PSMA is generally well tolerated due to its limited side effects. While PSMA is highly overexpressed in prostate cancer cells, varying degrees of PSMA expression have been reported in other malignancies as well, particularly in the tumor-associated neovasculature. Hence, it is anticipated that PSMA-RLT could be explored for other solid cancers. Here, we describe the current knowledge of PSMA expression in other solid cancers and define a perspective towards broader clinical implementation of PSMA-RLT. This review focuses specifically on salivary gland cancer, glioblastoma, thyroid cancer, renal cell carcinoma, hepatocellular carcinoma, lung cancer, and breast cancer. An overview of the (pre)clinical data on PSMA immunohistochemistry and PSMA PET/CT imaging is provided and summarized. Furthermore, the first clinical reports of non-prostate cancer patients treated with PSMA-RLT are described.
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A Case of Well-differentiated Hepatocellular Carcinoma Identified on Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography
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  • Apr 2018
Prostate-specific membrane antigen (PSMA) is a glycosylated type-II transmembrane protein highly expressed in certain tumor cells. To the best of our knowledge, this is the first case reported of an isolated well-differentiated hepatocellular carcinoma (HCC) strongly suspected on gallium-68 (68Ga)-PSMA positron emission tomography/computed tomography (PET/CT), which was not well characterized both on magnetic resonance imaging (MRI) liver with Primovist as well as fluorine-18 (18F)-choline PET/CT. Our patient had previous prostate cancer and previously was imaged using 18F-choline PET/CT. The last scan showed an indeterminate segment VII hypodensity which was not significantly choline-avid. The lesion was initially stable on serial MRI scans but then showed growth from 1.0 to 1.5 cm. 68Ga-PSMA PET/CT was performed. The lesion was intensely tracer-avid. This was surgically excised and histology confirmed the presence of well-differentiated HCC. Well-differentiated HCC can be optimally imaged using 68Ga-PSMA PET/CT and further prospective studies are needed to look into the potential of this imaging modality.
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The diagnostic value of PET/CT imaging with the 68Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer
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  • Nov 2014
Since the introduction of positron emission tomography (PET) imaging with (68)Ga-PSMA-HBED-CC (=(68)Ga-DKFZ-PSMA-11), this method has been regarded as a significant step forward in the diagnosis of recurrent prostate cancer (PCa). However, published data exist for small patient cohorts only. The aim of this evaluation was to analyse the diagnostic value of (68)Ga-PSMA-ligand PET/CT in a large cohort and the influence of several possibly interacting variables. We performed a retrospective analysis in 319 patients who underwent (68)Ga-PSMA-ligand PET/CT from 2011 to 2014. Potential influences of several factors such as prostate-specific antigen (PSA) level and doubling time (DT), Gleason score (GSC), androgen deprivation therapy (ADT), age and amount of injected tracer were evaluated. Histological verification was performed in 42 patients after the (68)Ga-PSMA-ligand PET/CT. Tracer uptake was measured in 901 representative tumour lesions. In 82.8 % of the patients at least one lesion indicative of PCa was detected. Tumor-detection was positively associated with PSA level and ADT. GSC and PSA-DT were not associated with tumor-detection. The average maximum standardized uptake value (SUVmax) of tumour lesions was 13.3 ± 14.6 (0.7-122.5). Amongst lesions investigated by histology, 30 were false-negative in 4 different patients, and all other lesions (n = 416) were true-positive or true-negative. A lesion-based analysis of sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) revealed values of 76.6 %, 100 %, 91.4 % and 100 %. A patient-based analysis revealed a sensitivity of 88.1 %. Of 116 patients available for follow-up, 50 received local therapy after (68)Ga-PSMA-ligand PET/CT. (68)Ga-PSMA-ligand PET/CT can detect recurrent PCa in a high number of patients. In addition, the radiotracer is highly specific for PCa. Tumour detection is positively associated with PSA and ADT. (68)Ga-PSMA-ligand PET/CT can help delay systemic therapy of PCa.
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Value of PET/CT in the Management of Primary Hepatobiliary Tumors, Part 2
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Objective: Primary hepatobiliary malignancies consist of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder cancer. Benign hepatic lesions include hepatic cysts, hemagiomas, adenomas, and focal nodular hyperplasias. The utility of PET/CT in imaging primary hepatobiliary lesions varies according to the type and location of the lesion. Conclusion: There is a consistent benefit to the use of PET/CT for detection and staging, and it ultimately helps to establish the best course of treatment and to determine prognosis. In addition, PET/CT is very useful in local ablative and systemic therapy assessment and surveillance for hepatobiliary malignancies.
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Evidence of Prostate-Specific Membrane Antigen Expression in Hepatocellular Carcinoma Using 68Ga-PSMA PET/CT
Article
  • Jul 2019
Prostate specific membrane antigen (PSMA) expression has been demonstrated in tumor neovasculature of many solid tumors, including hepatocellular carcinoma (HCC). The purpose of this study is to evaluate PSMA expression in patients with HCC. Materials and methods: Nineteen HCC patients who underwent F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) as part of restaging procedure also underwent Ga-PSMA PET. F-FDG PET and Ga-PSMA findings were compared visually as well as quantitatively using maximized standardized uptake values (SUVmax). Results: FDG was positive in 15 patients while 16 patients demonstrated PSMA expression. The only extrahepatic finding was one metastatic lymph node detected by both tracers. Mean SUVmax of liver lesions on FDG PET/CT was 8.3 ± 2.3 and mean tumor to background ratio was 2.3 ± 1.5. Respective values for Ga-PSMA PET/CT were 17.4 ± 9 and 3.3 ± 2.2. On visual and quantitative evaluation uptake was higher with PSMA in nine patients and higher with FDG in four patients. PSMA and FDG activity were similar in three patients. One of the FDG positive patients was PSMA negative whereas two patients were PSMA positive but FDG negative. Heterogeneous uptake pattern was observed in three patients. Comparison of mean SUVmax and T/B values between PET studies revealed no statistically significant difference (P > 0.1). The mean survival was 25 months (range: 18-32 months) and SUVmax of PSMA (P = 0.05) and FDG (P = 0.012) showed medium strength of correlation with overall survival. Conclusion: PSMA expression in advanced HCC can be demonstrated by Ga-PSMA PET but is not superior to FDG PET however it could be useful for identifying patients with limited therapeutic options.
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Heterogeneous Uptake of 18F-FDG and 68Ga-PSMA-11 in Hepatocellular Carcinoma
Article
  • Mar 2019
We present the case of an 87-year-old man with a history of melanoma metastatic to the lungs found to have an FDG-negative liver lesion that was initially thought to be benign. Follow-up CT revealed growth of the liver lesion despite excellent response to nivolumab therapy of the pulmonary melanoma metastases. Biopsy of the lesion confirmed primary hepatocellular carcinoma. Follow-up F-FDG PET/CT showed minimal FDG uptake, slightly above liver background, and subsequent Ga-PSMA-11 PET/MR showed focal, intense uptake of radiotracer in a different region of the tumor. These imaging findings support intratumor metabolic heterogeneity with radiotracer uptake in different tumor locations.
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68 Ga-PSMA is a novel PET-CT tracer for imaging of hepatocellular carcinoma: A prospective pilot study
Article
  • Jul 2018
Background:68Ga-Prostate Specific Membrane Antigen (68Ga-PSMA), a positron emission tomography (PET) tracer that was recently introduce for imaging of prostate cancer, may accumulate in other solid tumors including Hepatocellular Carcinoma (HCC). The aim of the study was to assess the potential role of 68Ga-PSMA PET-Computed Tomography (CT) for imaging of HCC. Material and Methods: A prospective pilot study in seven patients with HCC with 41 liver lesions: 37 suspected malignant lesions (tumor lesions) and 4 regenerative nodules. For each liver lesion, uptake of 68Ga-PSMA and 18F-FDG uptake were measured [standard uptake value (SUV) and lesion-to-liver background ratios (TBR-SUV)], and correlated with dynamic characteristics (HU and TBR-HU) obtained on contrast enhanced CT data. Immunohistochemistry staining of PSMA in the tumor tissue was analyzed in samples obtained from 5 patients with HCC and compared to control samples from 3 patients with prostate cancer. Results: Thirty-six of the 37 tumor lesions and none of the regenerative nodules showed increased 68Ga-PSMA uptake while only 10 lesions were 18F-FDG avid. Based on contrast enhancement, tumor lesions were categorized into 27 homogeneously enhancing lesions, nine lesions with "mosaic" enhancement composed of enhancing and non-enhancing regions in the same lesion and a single non-enhancing lesion, the latter being the only non-68Ga-PSMA avid lesion. Using the Mann-Whitney test, 68Ga-PSMA uptake was found significantly higher in enhancing tumor areas compared to non-enhancing areas and in contrast, 18F-FDG uptake was higher in non-enhancing areas, P<0.001 for both. 68Ga-PSMA uptake (TBR SUVmax) was found to correlate with vascularity (TBR-HU) (Spearman r=0.866, p<0.001). Immunohistochemistry showed intense intra-tumoral microvessel staining for PSMA in HCC, in contrast with cytoplasmic and membranous staining, mainly in the luminal border, in prostate cancer samples. In two of the study patients 68Ga-PSMA PET-CT identified unexpected extrahepatic metastases. Four regenerative liver nodules showed no increased uptake of either of the PET tracers. Conclusion:68Ga-PSMA PET-CT is superior to 18F-FDG PET-CT in imaging patients with HCC. HCC lesions are more commonly hypervascular taking up 68Ga-PSMA in tumoral micro-vessels. 68Ga-PSMA PET-CT is a potential novel modality for imaging patients with HCC.
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68Ga-PSMA Uptake in Hepatocellular Carcinoma
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  • Sep 2016
Ga-PSMA based integrated PET/MRI is emerging as a novel imaging technique for the staging of prostate carcinoma. We report a case of a 77-year-old man with raised prostate-specific antigen who presented to us for Glu-NH-CO-NH-Lys-(Ahx)-[Ga-(HBED-CC)] (Ga-PSMA) simultaneous PET/MRI scan for prostate cancer evaluation. A PSMA avid hepatic lesion on the background of cirrhotic liver was noted apart from PSMA avid lesion in the peripheral gland of the prostate. On histopathological examination, the hepatic lesion turned out to be hepatocellular carcinoma.
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