Update on PET Radiopharmaceuticals for Imaging Hepatocellular Carcinoma

SIMPLE SUMMARY: Hepatocellular carcinoma (HCC) causes significant mortality globally. The majority of patients experience resistance to systemic therapies and often undergo recurrence or disease progression even after aggressive local therapies. Management of HCC is determined by the extent and stage of the disease using blood tests and imaging tests per the BCLC guidelines. A number of positron emission tomography (PET) radiopharmaceuticals have been investigated with the aim of finding the most appropriate biomarker, which can help to accurately stage the disease to optimise treatment of this cancer. More trials are necessary to determine the accuracy of these PET radiotracers and their impacts on initial staging, assessing the treatment response and determining recurrence early enough to minimise morbidity. ABSTRACT: Numerous positron emission tomography (PET) targets for detection and staging of hepatocellular cancer have been developed in recent years. Hepatocellular carcinomas (HCCs) are clinically and pathologically heterogeneous tumours with a high tendency to be aggressive and unresponsive to chemotherapy. Early detection is essential, and the need for an adequate imaging biomarker, which can overcome some of the limitations of conventional radiological imaging, is persistent. Flourine-18 ((18)F) flourodeoxyglucose (FDG), the most widely used PET radiopharmaceutical, has proven disappointing as a possible staple in the evaluation of HCC. This disappointment had led to experimentation with carious radiotracers, such as the choline derivatives, acetate, and prostate-specific membrane antigen, which appear to complement and/or enhance the role of FDG. In this study, we look at the various PET radiopharmaceuticals that have been used for imaging HCC and the particular pathways that they target in HCC and liver cancers.