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Background & Aims: Combined 18F-fluorodeoxyglucose (FDG) and 11C-acetate (dual-tracer) positron-emission tomography/computed tomography (PET/CT) is being increasingly performed for the management of hepatocellular carcinoma (HCC), although its role is not well defined. Therefore, we evaluated its effectiveness in (i) staging, (ii) characterization of indeterminate lesions on conventional imaging, and (iii) detection of HCC in patients with unexplained elevations in serum alpha-fetoprotein (AFP) levels. Methods: We retrospectively assessed 525 consecutive patients from three tertiary centers between 2014 and 2020. For staging, we recorded new lesion detection rates, changes in the Barcelona Clinic Liver Cancer (BCLC) classification, and treatment allocation due to dual-tracer PET/CT. To characterize indeterminate lesions and unexplained elevation of serum AFP levels, the sensitivity and specificity of dual-tracer PET/CT in diagnosing HCC were evaluated. A multidisciplinary external review and a cost-benefit analysis of patients for metastatic screening were also performed. Results: Dual-tracer PET/CT identified new lesions in 14.3% of 273 staging patients, resulting in BCLC upstaging in 11.7% and treatment modifications in 7.7%. It upstaged 8.1% of 260 patients undergoing metastatic screening, with estimated savings of US$495 per patient. It had a sensitivity and specificity of 80.7% (95% CI 71.2-88.6%) and 94.8% (95% CI 90.4-98.6%), respectively, for diagnosing HCC in 201 indeterminate lesions. It detected HCC in 45.1% of 51 patients with unexplained elevations in serum AFP concentrations. External review revealed substantial agreement between local and external image interpretation and patient assessment (n = 273, κ = 0.822; 95% CI 0.803-0.864). Conclusions: Dual-tracer PET/CT provides added value beyond conventional imaging in patients with HCC by improving staging, confirming HCC diagnosis with high accuracy in patients with indeterminate lesions, and detecting HCC in patients with unexplained elevation of serum AFP. Impact and implications: Compared to CT or MRI, dual-tracer positron-emission tomography/computed tomography (PET/CT) led to upstaging in 12% of patients with hepatocellular carcinoma (HCC) undergoing staging, resulting in treatment modification in 8% of cases and a cost saving of US$495 per patient. It also accurately detected HCC in high-risk cases where CT or MRI were equivocal or normal. Dual-tracer PET/CT provides added value beyond conventional imaging in patients with HCC by improving staging, confirming HCC diagnosis with high accuracy in patients with indeterminate lesions, and detecting HCC in patients with unexplained elevation of serum AFP.
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OBJECTIVES: We aimed to determine the prevalence of chronic and past hepatitis B virus (HBV) infection in Chinese patients with inflammatory bowel disease (IBD), and to determine the risk factors associated with having received no vaccination for HBV and abnormal liver function among our patients. METHODS: The prevalence of chronic or past infection with HBV infection and effective HBV vaccination were determined in patients with IBD who attended the IBD Clinic of the Queen Mary Hospital in Hong Kong, China. Risk factors associated with the absence of HBV vaccination and abnormal liver function were identified. RESULTS: A total of 267 Chinese IBD patients (166 ulcerative colitis and 101 Crohn's disease) were enrolled. The mean follow-up period was 10.5 years. Chronic and past HBV infection was detected in 6.7% and 28.5% patients, respectively. Altogether 102 patients lacked effective HBV vaccination. Multivariate analysis found that elder age at diagnosis of IBD (OR 1.02, 95% CI 1.00-0.94) and the absence of using thiopurine (OR 0.53, 95% CI 0.29-0.94) were associated with the presence of anti-HBs. Abnormal liver function was detected in 27 (10.1%) patients. The use of anti-tumor necrosis factor agents (OR 4.6, 95% CI 1.3-16.0), previous bowel resection (OR 3.7, 95% CI 1.5-9.2) and male gender (OR 4.4, 95% CI 1.4-13.7) were significant risk factors for abnormal liver function. CONCLUSIONS: The use of thiopurine and younger age at diagnosis were associated with no vaccination against HBV in Chinese IBD patients. Chronic or past HBV infection was, however, not associated with abnormal liver function in these patients.
