title: The role of 18F-FDG accumulation and arterial enhancement as biomarkers in the assessment of typing, grading and staging of hepatocellular carcinoma using 18F-FDG-PET/CT with integrated dual-phase CT angiography.
abstract: OBJECTIVE
  The purpose of the present study was to evaluate the possibility of detection, staging and differentiation assessment of hepatocellular carcinoma (HCC) using a combination of dual-phase computed tomography (CT)-angiography in the arterial and portal phase with positron emission tomography (PET) imaging using (18)F-fluorodeoxyglucose ((18)FDG).
  
  
  METHODS
  From a set of 10,000 patients who underwent (18)FDG-PET/CT, we examined a total of 65 patients (52 males, 13 females; mean age=61.7 years, ranging from 35-82 years) with HCC. The imaging included CT data acquisition after intravenous application of iodinated contrast material in arterial and portal phases, allowed to obtain data in CT angiography quality. Histological diagnosis of the resection sample (21), biopsy (37) or necropsy (7), including the evaluation of the hepatocytary origin of the tumor and the grade of its differentiation, was determined in all patients.
  
  
  RESULTS
  The most sensitive sign in the detection of HCC was the alternative presence of hypervascularity or hyperaccumulation of (18)F FDG that reached 93.8%. The high level of (18)F-FDG accumulation showed sensitivity of 84.1% and specificity of 75.0% for distinguishing between well- and poorly differentiated HCC.
  
  
  CONCLUSIONS
  The combination of the dual-phase CT angiography with (18)FDG PET helps in the assessment of staging and differentiation of HCC and has an important role in treatment decision-making.
authors: Department of Imaging Methods, Charles University Teaching Hospital Pilsen, Pilsen, Czech Republic Biomedical Centre, Biomedical Centre, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic ferda@fnplzen.cz.
authors: Jiří
authors: J
authors: Ferda
authors: Department of Imaging Methods, Charles University Teaching Hospital Pilsen, Pilsen, Czech Republic.
authors: Eva
authors: E
authors: Ferdová
authors: Department of Imaging Methods, Charles University Teaching Hospital Pilsen, Pilsen, Czech Republic.
authors: Jan
authors: J
authors: Baxa
authors: Department of Imaging Methods, Charles University Teaching Hospital Pilsen, Pilsen, Czech Republic.
authors: Boris
authors: B
authors: Kreuzberg
authors: Institute of Pathology, Charles University Teaching Hospital Pilsen, Pilsen, Czech Republic.
authors: Ondřej
authors: O
authors: Daum
authors: Department of Surgery, Charles University Teaching Hospital Pilsen, Pilsen, Czech Republic Biomedical Centre, Biomedical Centre, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
authors: Vladislav
authors: V
authors: Třeška
authors: Department of Surgery, Charles University Teaching Hospital Pilsen, Pilsen, Czech Republic.
authors: Tomáš
authors: T
authors: Skalický
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-fluorodeoxyglucose; Hepatocellular carcinoma; PET/CT; positron emission tomography