Positron Emission Tomography Applications in Hepatocellular Carcinoma

Positron emission tomography (PET) has emerged as a vital tool in the detection, characterisation and management of hepatocellular carcinoma (HCC). By visualising metabolic activity within liver lesions, PET complements conventional imaging modalities and offers unique insights into tumour biology. Fluorine-18 fluorodeoxyglucose (18F-FDG) remains the most widely employed tracer, although its sensitivity varies with tumour differentiation and size. Alternative radiotracers such as 11C-acetate or 18F-choline have been developed to overcome limitations of FDG in well-differentiated tumours. Dual-tracer approaches exploit the heterogeneous metabolic pathways of HCC, enhancing detection rates for both primary and metastatic lesions. Advances in hybrid PET/CT and PET/MRI platforms enable precise anatomical localisation alongside functional data, while quantitative parameters—most notably the standardised uptake value (SUV)—inform prognosis and treatment planning. Artificial intelligence and deep-learning algorithms are increasingly applied for automated lesion segmentation and risk stratification, and PET-based biomarkers are under investigation to guide patient selection for surgical resection, locoregional therapies and liver transplantation. As research continues to refine tracer selection and image analysis, PET stands poised to play a central role in personalised management of HCC, supporting earlier diagnosis, accurate staging and tailored therapeutic decision-making on a global scale.

Research from Nature Portfolio

Investigations into tumour microenvironment and metabolic stress have highlighted the role of glucose deprivation under hypoxia in driving epithelial–mesenchymal transition within HCC. Studies demonstrate that low glucose uptake regions, identifiable by reduced 18F-FDG accumulation, coincide with increased markers of invasive phenotype and may predict metastatic potential. This integrated metabolic–functional analysis suggests combined assessment of hypoxia, proliferation and FDG uptake can improve prognostication.

Work on extending liver transplant criteria has combined radiographic size-number thresholds (the “Up-to-seven” rule) with PET avidity. Patients exceeding conventional morphological limits but exhibiting low or absent 18F-FDG uptake achieved recurrence-free survival comparable to those within criteria. Conversely, high PET avidity identified candidates at elevated risk of microvascular invasion and post-transplant recurrence. This synergy of metabolic and anatomic parameters offers a refined framework for expanding transplant eligibility safely.

Positron Emission Tomography Applications in Hepatocellular Carcinoma publication trend

The graph below shows the total number of articles in positron emission tomography applications in hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Positron Emission Tomography (PET): An imaging technique that detects radioactive tracer emissions to map metabolic activity in tissues.

Radiotracer: A biologically active molecule labelled with a positron-emitting isotope, used to visualise specific metabolic or molecular processes.

Standardised Uptake Value (SUV): A quantitative metric reflecting tracer concentration in tissue normalised to injected dose and patient body weight.

18F-Fluorodeoxyglucose (18F-FDG): A glucose analogue tracer widely used in PET to assess glycolytic activity in tumours.

Dual-tracer PET: The combined use of two different radiotracers in a single imaging session to exploit complementary metabolic pathways.

References

1. Update on PET Radiopharmaceuticals for Imaging Hepatocellular Carcinoma. Cancers (2023).
2. Predicting Overall Survival with Deep Learning from 18F-FDG PET-CT Images in Patients with Hepatocellular Carcinoma before Liver Transplantation. Diagnostics (2023).
3. Multiparametric FDG‐PET/MRI of Hepatocellular Carcinoma: Initial Experience. Contrast Media & Molecular Imaging (2018).
4. 18F-FDG /18F-Choline Dual-Tracer PET Behavior and Tumor Differentiation in HepatoCellular Carcinoma. A Systematic Review. Frontiers in Medicine (2022).
5. The critical role of glucose deprivation in epithelial-mesenchymal transition in hepatocellular carcinoma under hypoxia. Scientific Reports (2020).
6. Combining 18F-FDG positron emission tomography with Up-to-seven criteria for selecting suitable liver transplant patients with advanced hepatocellular carcinoma. Scientific Reports (2017).