Chapter 7 – Hepatobiliary Cancer

Hepatocellular carcinoma (HCC) is the sixth most common malignancy in Asia and Africa and constitutes 70%–85% of primary liver cancers. In addition to clinical information, benign findings and pitfalls in PET/CT reading using various radiotracers, and teaching cases, this chapter reviews evidence-based recommendations regarding PET/CT examination in hepatobiliary cancers and compares them with statements in major clinical guidelines. According to evidence-based data, fludeoxyglucose (FDG) PET/CT was useful in ruling in extrahepatic metastases and valuable for ruling out recurrent HCC. Although radiolabeled choline PET/CT could be a valuable tool in detecting this malignancy, especially in well- to moderately differentiated lesions, poorly differentiated and higher-stage HCC could be more accurately evaluated with FDG and dual-tracer imaging. Cholangiocarcinoma is the second most common primary hepatic malignancy. Gallbladder cancer presents in the liver in 70% and with regional lymph node metastases in 50% of patients. FDG PET/CT has been demonstrated to be an accurate diagnostic imaging method in the assessment of both primary tumors. A positive PET/CT would lead to a decision not to operate on the patient. It is useful in detecting recurrent and metastatic disease in patients with abnormalities on CT or MRI.