title: FDG PET/CT early dynamic blood flow and late standardized uptake value determination in hepatocellular carcinoma.
abstract: OBJECTIVE
  To prospectively determine whether fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) early dynamic blood flow estimates could be used to discriminate hepatocellular carcinoma (HCC) from background liver and to characterize HCC in patients with and those without angioinvasion; and to evaluate the association between blood flow measures at FDG PET/CT with metabolism in HCCs.
  
  
  METHODS
  Institutional review board approval and written informed consent were obtained for this prospective study. Twenty-one consecutive patients (mean age, 65 years) with 30 established HCCs (mean size, 5.5 cm; seven lesions in five patients with angioinvasion) underwent a blood flow study with an FDG dynamic scan divided into 18 sequences of 5 seconds each and a standard PET/CT scan. On the dynamic study, three independent operators obtained volumes of interest (VOIs) for which three blood flow estimates were calculated (hepatic perfusion index [HPI], time to peak [TTP], and peak intensity [PI]). On the late study, a VOI was placed on the fused scan for each HCC, and maximum standardized uptake value (SUV(max)) was obtained. By using a mixed-effects model analysis, comparison of blood flow estimates between HCC with and that without angioinvasion and background liver was performed. The association between blood flow estimates and SUV(max) was also assessed.
  
  
  RESULTS
  HPI and TTP showed better performance than did SUV(max) for discriminating HCC and background liver (areas under receiver operating characteristic curve: 0.96, 0.95, and 0.83, respectively; P < .05). HPI was higher in HCC in patients with angioinvasion (0.91 ± 0.15 [standard deviation]) than in those without angioinvasion (0.80 ± 0.18; P = .03). There was no difference in SUV(max) between HCC in patients with and those without angioinvasion (7.8 ± 2.9 vs 6.3 ± 3.4; P = .85). No clear association was found between HPI, PI, or TTP and SUV(max) (P = .49, .77, and .91, respectively).
  
  
  CONCLUSIONS
  Early dynamic blood flow FDG PET/CT may be used to help discriminate and characterize HCC tumors.
authors.affiliation: Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Hanna
authors.initials: H
authors.lastname: Bernstine
authors.forename: Marius
authors.initials: M
authors.lastname: Braun
authors.forename: Nikolay
authors.initials: N
authors.lastname: Yefremov
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Lamash
authors.forename: Raz
authors.initials: R
authors.lastname: Carmi
authors.forename: Dorit
authors.initials: D
authors.lastname: Stern
authors.forename: Adam
authors.initials: A
authors.lastname: Steinmetz
authors.forename: Jacob
authors.initials: J
authors.lastname: Sosna
authors.forename: David
authors.initials: D
authors.lastname: Groshar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D019275:Radiopharmaceuticals; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18