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Background  Positron emission tomography (PET) with the liver-specific galactose tracer 2-[ 18 F]fluoro-2-deoxy- d -galactose ( 18 F-FDGal) may improve diagnosis of hepatocellular carcinoma (HCC). The aim of this study was to test which of three different  18 F-FDGal PET protocols gives the highest tumour-to-background (T/B) ratio on PET images and thus better detection of HCC tumours.    Methods  Ten patients with a total of 15 hepatic HCC tumours were enrolled prior to treatment. An experienced radiologist defined volumes of interest (VOIs) encircling HCC tumours on contrast-enhanced CT (ce-CT) images. Three PET/CT protocols were conducted following an intravenous  18 F-FDGal injection: (i) a 20-min dynamic PET/CT of the liver (to generate a 3D metabolic image), (ii) a traditional static whole-body PET/CT after 1 h, and (iii) a late static whole-body PET/CT after 2 or 3 h. PET images from each PET/CT protocol were fused with ce-CT images, and the average standardized uptake values (SUV) in tumour and background liver tissue were used to calculate (T/B) ratios. Furthermore, T peak /B ratios were calculated using the five hottest voxels in all  hot  tumours. The ratios for the three different PET protocols were compared.    Results  For the individual tumours, there was no significant difference in the T/B ratio between the three PET protocols. The metabolic image yielded higher T peak /B ratios than the two static images, but it was easier to identify tumours on the static images. One extrahepatic metastasis was detected.    Conclusions  Neither metabolic images nor static whole-body images acquired 2 or 3 h after  18 F-FDGal injection offered an advantage to traditional whole-body PET/CT images acquired after 1 h for detection of HCC.

Optimal 2-[18F]fluoro-2-deoxy-d-galactose PET/CT protocol for detection of hepatocellular carcinoma