What is the role of nuclear imaging in the workup of hepatocellular carcinoma (HCC)?

Updated: Jul 31, 2019
  • Author: Daniel R Jacobson, MD, MS; Chief Editor: John Karani, MBBS, FRCR  more...
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Answer

Answer

On a gallium scan, up to 90% of hepatocellular carcinomas (HCCs) demonstrate uptake of the radiopharmaceutical. Gallium may help distinguish regenerating nodules of cirrhosis from HCC, as regenerating nodules typically do not label with gallium.

On a liver-spleen scan, a sulfur-colloid study typically demonstrates an area of decreased labeling in HCC. Look for signs of cirrhosis, such as heterogeneous labeling of the liver with a large spleen and colloid shift to the bone marrow. Prominent left and caudate lobes of the liver are also signs of cirrhosis. A "cold" defect in the liver with signs of cirrhosis strongly suggests HCC.

Hepatobiliary scans can show labeling of HCC due to the presence of hepatocytes. HCC may have no uptake initially but may show delayed uptake as the rest of the normal liver clears. This is related to malignant hepatocytes, which are hypofunctional relative to normal hepatocytes.

Positron emission tomography with fluorodeoxyglucose (FDG-PET) is primarily useful in assessing the degree of differentiation and in staging moderately and poorly differentiated tumors, rather than in primary lesion detection. Sensitivity of FDG-PET for the detection of HCC is 50-70%. This limited sensitivity is due to the low level of FDG uptake in well-differentiated tumors; however, FDG-PET may be superior to CT in detecting extrahepatic spread.

On a gallium scan, the liver normally labels early and may obscure HCC labeling. Differential diagnoses of a mass that shows labeling in the liver include other types of malignancy and infection.


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