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Abstract

(18)F-FDG PET is an effective method of predicting recurrence of hepatocellular carcinoma (HCC) after liver transplantation. We compared recently introduced metabolic and volumetric (18)F-FDG PET/CT indices with the current clinicopathologic predictors for ability to predict recurrence.

METHODS:

In total, 110 HCC patients who underwent (18)F-FDG PET and liver transplantation were enrolled. On PET, SUVs and tumor-to-background ratios (TBRs) were measured as metabolic activity indices. Various metabolic tumor volumes and uptake-volume products (UVP) were also measured as volumetric indices. The ability of these indices and other clinicopathologic factors to predict recurrence was compared.

RESULTS:

All metabolic and volumetric indices were significant for recurrence prediction on receiver-operating-characteristic curve analyses (P < 0.001). On univariate survival analyses, all PET indices-as well as tumor size, tumor number, the Milan criteria, tumor grade, vascular invasion, and T-stage-were significant factors. However, on multivariate analyses, tumor size, tumor grade, maximum TBR, and UVP calculated by inferior vena cava activity were significant factors (P = 0.004, 0.014, 0.009, and 0.021, respectively). When the Milan criteria and PET factors were included in the multivariate analysis, the Milan criteria (P = 0.029), maximum TBR (P < 0.001), and UVP (P = 0.016) were significant.

CONCLUSION:

Volumetric and metabolic activity indices of (18)F-FDG PET are effective predictors of posttransplantation HCC recurrence. In addition to clinicopathologic factors, these indices need to be considered in the selection of candidates for liver transplantation. 

Author information

Kim YI1, Paeng JC2, Cheon GJ3, Suh KS4, Lee DS5, Chung JK3, Kang KW3.

1Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea; and.

2Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea paengjc@snu.ac.kr.

3Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

4Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

5Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea; and.