Splenic and lung metastases of hepatocellular carcinoma detected at 13N-ammonia PET/CT

Scolozzi, Valentina; Giancipoli, Romina Grazia; Inzani, Frediano; Ponziani, Francesca Romana; Taralli, Silvia

doi:10.1016/j.remnie.2023.06.006

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Images in axial sections. Well-delimited, hypermetabolic mass (SUVmax: 3), 3.2×4.1×4.6cm (AP, LL, CC), with homogeneous contrast enhancement, located in the left flank, anterior to the psoas muscle, and inferior to the left kidney (yellow wide arrows). D-F) 18F-FDG PET/CT. Coronal slice images. In addition to the described mass (wide yellow arrows), venous branches that originate directly from the portal vein (narrow green arrows) converge in this mass." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Álvaro Badenes Romero, Marta Milà López, Rolando Omar Vallansot, Carlos Andrés Achury Murcia, Maria Patricia Fierro Alanis, David Carrera Salazar, Vicente Izquierdo Muro, Liliana María Quintero Caicedo" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Álvaro" "apellidos" => "Badenes Romero" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Milà López" ] 2 => array:2 [ "nombre" => "Rolando Omar" "apellidos" => "Vallansot" ] 3 => array:2 [ "nombre" => "Carlos Andrés" "apellidos" => "Achury Murcia" ] 4 => array:2 [ "nombre" => "Maria" "apellidos" => "Patricia Fierro Alanis" ] 5 => array:2 [ "nombre" => "David" "apellidos" => "Carrera Salazar" ] 6 => array:2 [ "nombre" => "Vicente Izquierdo" "apellidos" => "Muro" ] 7 => array:2 [ "nombre" => "Liliana María" "apellidos" => "Quintero Caicedo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X23000793" "doi" => "10.1016/j.remn.2023.06.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X23000793?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808923000642?idApp=UINPBA00004N" "url" => "/22538089/0000004200000006/v1_202311030524/S2253808923000642/v1_202311030524/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808923000587" "issn" => "22538089" "doi" => "10.1016/j.remnie.2023.06.003" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "1446" "copyright" => "The Authors" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2023;42:413-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Interesting images" "titulo" => "99mTc-MIP-1404 CZT SPECT/CT versus 68Ga/PSMA-11 PET/CT: Imaging of prostate cancer metastasis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "413" "paginaFinal" => "415" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "99mTc-MIP-1404 CZT SPECT/TC versus 68Ga-PSMA-11 PET/TC: diagnóstico por imagen de las metástasis en el cáncer de próstata" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2050 "Ancho" => 3341 "Tamanyo" => 218221 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "CZT SPECT/CT whole body bone scan performed after the intravenous administration of 500 MBq 99mTc-HDP, showing no uptake suspicious for skeletal metastases. 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Gemelli IRCCS, Roma, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Internal Medicine and Gastroenterology — Hepatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Università cattolica del sacro Cuore, Roma, Italy" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis esplénica y pulmonar de carcinoma hepatocelular detectado en 13N-NH3 PET/TC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1179 "Ancho" => 3341 "Tamanyo" => 1046760 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "At EUS-needle biopsy of the splenic nodule, histological examination revealed a solid-trabecular proliferation of atypical epithelial cells with prominent nucleoli (H&E, A) with diffuse expression of HepPar1 at immunohistochemistry (immunoperoxidase, B), consistent with HCC localization." ] ] ] "textoCompleto" => "We report the case of a 62-year-old man with history of surgically treated advanced hepatocellular carcinoma (HCC). A restaging CT scan performed for markedly increase of serum alpha-fetoprotein level described a nodule in the upper splenic pole (axial diameter: 35mm) and two other nodules in the right lung (axial diameter: 14mm and 10mm), all findings suggestive for HCC metastases. As candidate to systemic therapy with an anti-angiogenic tyrosine kinase inhibitor, the patient was enrolled in a prospective clinical trial that included a dynamic PET/CT with the perfusion tracer 13N-ammonia, to evaluate both lesions’ perfusion and disease extent. A dynamic PET/CT acquisition, lasting 20min and centred on the upper abdomen, was performed simultaneously with the intravenous injection of 370MBq of 13N-ammonia, followed by a whole-body acquisition. PET images showed focal increased 13N-ammonia uptake in both pulmonary lesions and in the splenic nodule, consistent with HCC localizations (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No other foci of abnormal tracer uptake were observed. At subsequent endoscopic ultrasound (EUS)-needle biopsy of the splenic nodule, histological examination proved HCC metastasis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The planned systemic treatment was started.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>While lung involvement from HCC is not so infrequent, splenic metastases are sporadic findings seen in approximately 0.8% of cases, usually spreading by hematogenous route or direct seeding. To our knowledge, our case is the first in literature reporting on the detection of HCC splenic metastasis at PET/CT with 13N-ammonia, a perfusion tracer historically used in clinical practice to measure myocardial perfusion. The diagnostic performance of 13N-ammonia was also evaluated in the oncology field, with several neoplasms (including HCC) showing increased tracer uptake, depending on tumour capillary blood flow and tracer extraction efficiency.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In particular, the 13N-ammonia uptake degree in neoplastic cells also depends on up- or down-regulation of specific enzymes responsible for the amino acid synthesis, such as glutamine synthetase. The application of 13N-ammonia PET in HCC was firstly investigated by Hayashi et al. and Shibata et al., demonstrating a relationship between tumour vascularization and tracer uptake.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> Indeed, given the rich blood supply of HCC from the hepatic artery, 13N-ammonia mainly flows into HCC primary lesions in the early phase of the dynamic acquisition, displaying high tumour uptake and an optimal visual contrast to normal liver parenchyma, that shows more gradual radiotracer accumulation over time (blood supply mostly derived from the portal vein). In our case, the high 13N-ammonia uptake observed in distant metastases suggests that HCC localizations may share a similar PET pattern with primary tumour, reflecting similar perfusion behaviour.Conflict of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1403 "Ancho" => 3341 "Tamanyo" => 270181 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Maximum intensity projection (A), axial PET and fused PET/CT images showed high 13N-ammonia uptake in two pulmonary nodules located in the anterior basal segment of the right lower lobe (B, C, arrowed) and in the middle lobe (D, E, arrowed), respectively, and in a hypodense nodule in the upper splenic pole (F, G, arrowed)." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1179 "Ancho" => 3341 "Tamanyo" => 1046760 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "At EUS-needle biopsy of the splenic nodule, histological examination revealed a solid-trabecular proliferation of atypical epithelial cells with prominent nucleoli (H&E, A) with diffuse expression of HepPar1 at immunohistochemistry (immunoperoxidase, B), consistent with HCC localization." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "(13)N-NH3 PET/CT in oncological disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Albano" 1 => "R. Giubbini" 2 => "F. Bertagna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Jpn J Radiol" "fecha" => "2019" "volumen" => "37" "paginaInicial" => "799" "paginaFinal" => "807" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging of the hepatocellular carcinoma using dynamic positron emission tomography with nitrogen-13 ammonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Hayashi" 1 => "N. Tamaki" 2 => "Y. Yonekura" 3 => "M. Senda" 4 => "H. Saji" 5 => "K. Yamamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Nucl Med" "fecha" => "1985" "volumen" => "26" "paginaInicial" => "254" "paginaFinal" => "257" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dynamic positron emission tomography with 13N-ammonia in liver tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Shibata" 1 => "K. Yamamoto" 2 => "N. Hayashi" 3 => "Y. Yonekura" 4 => "T. Nagara" 5 => "H. Saji" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF00251784" "Revista" => array:6 [ "tituloSerie" => "Eur J Nucl Med" "fecha" => "1988" "volumen" => "14" "paginaInicial" => "607" "paginaFinal" => "611" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2854065" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000004200000006/v1_202311030524/S2253808923000617/v1_202311030524/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000004200000006/v1_202311030524/S2253808923000617/v1_202311030524/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808923000617?idApp=UINPBA00004N"]

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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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Vol. 42. Issue 6.

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