Glypican-3-Targeted PET/MR Identifies MRI-Indeterminate Early Hepatocellular Carcinoma in Cirrhosis.

Glypican-3 (GPC3) is highly expressed in hepatocellular carcinoma. A 72-year-old man with hepatitis B-related cirrhosis and rising alpha-fetoprotein had a small hepatic nodule on gadoxetic acid-enhanced MRI (EOB-MRI). The nodule enlarged on 3 consecutive EOB-MRI examinations during a 5-month follow-up but remained indeterminate for hepatocellular carcinoma. GPC3-targeted PET/MR showed intense uptake in the lesion and no extrahepatic disease, and hepatectomy confirmed moderately differentiated hepatocellular carcinoma with strong GPC3 expression. This case suggests the potential value of GPC3-targeted PET/MR for clarifying MRI-indeterminate early hepatocellular carcinoma.