title: Positioning of 18F-fluorodeoxyglucose-positron emission tomography imaging in the management algorithm of hepatocellular carcinoma.
abstract: OBJECTIVE
  (18) F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) may detect primary lesions (PLs) and extrahepatic metastases (EHMs) only in advanced hepatocellular carcinoma (HCC) patients. We investigated the requirement of PET and the optimal timing of PET scanning for accurate staging and treatment planning.
  
  
  METHODS
  We conducted a retrospective investigation of 64 HCC patients who underwent PET (median age, 74 years; male/female, 41/23; etiology, 46 hepatitis C virus/4 hepatitis B virus/4 alcoholic/10 others). To determine the best timing for PET examinations, we analyzed PET result-based recommended treatment changes and characteristics of patients with FDG-avid PLs or EHMs.
  
  
  RESULTS
  FDG-avid PLs were detected by PET in 22 patients (34%): 18 with hypervascular PL, 11 with serum α-fetoprotein levels ≥ 200 ng/mL, and 11 beyond Milan criteria. EHMs were detected in 21 patients (33%: lymph nodes, 8; lung, 5; abdominal wall, 4; bone, 3; other organs, 4 [including overlapping]). Recommended treatments changed for 16 patients (25%) because of Barcelona Clinic Liver Cancer stage increases based on PET scanning. In multivariate analyses, serum α-fetoprotein levels ≥ 200 ng/mL and beyond Milan criteria were independent factors for FDG-avid PLs and a maximum standardized uptake value (SUVmax) of PLs of ≥ 4.0 was an independent factor for FDG-avid EHMs (P = 0.002, 0.008, and 0.045, respectively).
  
  
  CONCLUSIONS
  PET allows detection of HCC spread in patients with elevated serum α-fetoprotein levels or those beyond Milan criteria and detects EHMs in patients with PLs with high SUVmax values. Optimally timed PET scans can complement conventional imaging for accurate staging and treatment strategy determination.
authors.affiliation: Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Etsushi
authors.initials: E
authors.lastname: Kawamura
authors.forename: Susumu
authors.initials: S
authors.lastname: Shiomi
authors.forename: Kohei
authors.initials: K
authors.lastname: Kotani
authors.forename: Joji
authors.initials: J
authors.lastname: Kawabe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hagihara
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Sawako
authors.initials: S
authors.lastname: Uchida-Kobayashi
authors.forename: Shuji
authors.initials: S
authors.lastname: Iwai
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Morikawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Enomoto
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Murakami
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tamori
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kawada
mesh_terms: D000368:Aged; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Barcelona Clinic Liver Cancer staging; FDG PET; extrahepatic metastases; liver cancer; treatment algorithm