(68)Ga-Prostate-Specific Membrane Antigen Uptake as a Surrogate Biomarker of Neovascularity in Hepatocellular Carcinoma

(68)Ga-prostate-specific membrane antigen ((68)Ga-PSMA) is expressed in the endothelium of tumor-associated neovasculature of various solid malignancies possibly due to tumor-associated angiogenic factors and endothelial cell sprouting. We report a case of a 45-year-old man with known colorectal cancer, cirrhosis, and hepatitis C. Contrast-enhanced computed tomography (CT) showed a hypervascular lesion in the liver, and (18)F-fluorodeoxyglucose positron emission tomography (PET) did not show any suspicious hepatic uptake. (68)Ga-PSMA PET-CT showed predominantly heterogeneous perilesional uptake in a configuration similar to the arterial enhancement pattern on the diagnostic CT. (68)Ga-PSMA uptake in hepatocellular carcinoma appears to be primarily neoangiogenesis driven, and its morphological and functional characterization can subsequently influence the selection of anti-neoangiogenic chemotherapy agents as well as guiding radionuclide ligand therapy.