Clinical and Translational Imaging

, Volume 7, Issue 4, pp 237–253 | Cite as

Detection rate of radiolabelled choline PET or PET/CT in hepatocellular carcinoma: an updated systematic review and meta-analysis

  • Giovanni Signore
  • Marie Nicod-Lalonde
  • John O. Prior
  • Francesco Bertagna
  • Barbara Muoio
  • Luca Giovanella
  • Caterina Furlan
  • Giorgio TregliaEmail author
Part of the following topical collections:
  1. Gastrointestinal tract



Different imaging methods have been used to detect hepatocellular carcinoma (HCC). As there are increasing literature data about the role of radiolabelled choline PET/CT in this setting, we aimed to perform an updated meta-analysis about the detection rate (DR) of this imaging method in HCC.


A comprehensive computer literature search of studies published through December 2018 in PubMed/MEDLINE, Embase and Cochrane library databases regarding the DR of radiolabelled choline PET or PET/CT in patients with HCC was carried out. Pooled DR were calculated on a per patient- and on a per lesion-based analysis. Subgroup analyses taking into account the radiopharmaceutical used were performed.


Nine studies (283 HCC patients) were included in the pooled analysis. The pooled DR of radiolabelled choline PET or PET/CT on a per patient- and on a per lesion-based analysis was 83% [95% confidence interval (95% CI) 75–89%] and 79% (95% CI 72–86%), respectively. A significant heterogeneity among the studies was found on a per lesion-based analysis only. No significant publication bias was found. The subgroup analysis demonstrated a trend towards a higher DR when using 18F-choline compared to 11C-choline, without a statistically significant difference. Pooled DR of HCC using dual-tracer PET/CT (radiolabelled choline and 18F-FDG) on a per patient- and a per lesion-based analysis was 91% (95% CI 87–95%) and 89% (95% CI 80–95%), respectively, without significant heterogeneity.


Radiolabelled choline PET/CT demonstrated good ability in detecting HCC. The DR increased when dual-tracer PET/CT was performed. Large multicenter studies and cost-effectiveness analyses are warranted.


PET Positron emission tomography Choline Hepatocellular carcinoma Liver Meta-analysis 



The authors declare that they have no financial or non-financial competing interests.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest relevant to this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Italian Association of Nuclear Medicine and Molecular Imaging 2019

Authors and Affiliations

  1. 1.School of MedicineSapienza University of RomeRomeItaly
  2. 2.Department of Nuclear Medicine and Molecular ImagingLausanne University HospitalLausanneSwitzerland
  3. 3.Faculty of Biology and MedicineUniversity of LausanneLausanneSwitzerland
  4. 4.Department of Nuclear MedicineUniversity of Brescia and Spedali Civili di BresciaBresciaItaly
  5. 5.Department of Internal MedicineEnte Ospedaliero CantonaleBellinzonaSwitzerland
  6. 6.Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern SwitzerlandEnte Ospedaliero CantonaleBellinzona/LuganoSwitzerland
  7. 7.Faculty of MedicineUniversity of ZürichZurichSwitzerland
  8. 8.Department of Clinical MedicineSapienza University of RomeRomeItaly
  9. 9.Health Technology Assessment UnitEnte Ospedaliero CantonaleBellinzonaSwitzerland
  10. 10.Department of Tropical and Infectious DiseasesPoliclinico Umberto IRomeItaly

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