title: Functional imaging of hepatocellular carcinoma using diffusion-weighted MRI and (18)F-FDG PET/CT in patients on waiting-list for liver transplantation.
abstract: BACKGROUND
  To compare the apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) with the standardized uptake values (SUV) measured by(18)F-FDG-PET/CT in naïve hepatocellular carcinoma (HCC) nodules, and to determine whether these markers are associated with tumours at high-risk of aggressiveness.
  
  
  METHODS
  From 2007 to 2010, all patients with HCC on the waiting list for liver transplantation and who underwent both FDG-PET/CT and 1.5-T DWI-MRI (b values: 0, 200, 400, and 800 s/mm(2)) were included in this institutional review board-approved retrospective study. Tumour size, tumour ADC, tumour-to-liver ADC ratio (ADCT/L), maximal tumour SUV and tumour-to-liver SUV ratio (SUVT/L) were measured and compared to serum alpha-fetoprotein (AFP) levels, tumour size and differentiation grade on explanted specimens.
  
  
  RESULTS
  A total of 37 HCC nodules in 28 patients were available for correlation between MRI and PET/CT, 7 of which (in 7 patients) showed a SUVT/L > 1.15. We did not find any correlation between tumour ADC or ADCT/L and tumour SUV or SUVT/L. To note, SUVT/L was positively correlated with AFP levels (R = 0.95, P ≤ 0.0001), while ADCT/L was not (P = 0.73). Twenty-four patients (with 32 nodules) underwent liver transplantation. In this subgroup, an increased SUVT/L ratio was associated with larger tumours (average size, 32 ± 14 mm; range, 18-60 mm; P < 0.0001) and with poor differentiation on pathology (grades 3 and 4; P = 0.04), while ADCT/L was neither associated with tumour size or differentiation grade.
  
  
  CONCLUSIONS
  ADC and SUV measures in HCC nodules are not correlated. SUVT/L ratio correlates with AFP levels, tumour size and poor differentiation, and should probably be integrated as a co-variable in a predictive outcome model of patients on the waiting-list for liver transplantation.
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. samiaboussouar@gmail.com.
authors.forename: Samia
authors.initials: S
authors.lastname: Boussouar
authors.affiliation: Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. emmanuel.itti@aphp.fr.|AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France. emmanuel.itti@aphp.fr.|INSERM Unité U 955, GRC Amyloid Research Institute, Créteil, F-94010, France. emmanuel.itti@aphp.fr.|Service de Médecine Nucléaire, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Créteil, Cedex, France. emmanuel.itti@aphp.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Itti
authors.affiliation: Biomedical Informatics, Stanford University, Stanford, CA, 94305, USA. shihjui@gmail.com.
authors.forename: Shih-Jui
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. tdecaens@chu-grenoble.fr.|AP-HP, Hôpitaux Universitaires Henri Mondor, Hépatologie, Créteil, F-94010, France. tdecaens@chu-grenoble.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Decaens
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France. eva.evangelista@aphp.fr.
authors.forename: Eva
authors.initials: E
authors.lastname: Evangelista
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. melanie.chiaradia@aphp.fr.|Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. melanie.chiaradia@aphp.fr.
authors.forename: Melanie
authors.initials: M
authors.lastname: Chiaradia
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France. julia.chalaye@aphp.fr.
authors.forename: Julia
authors.initials: J
authors.lastname: Chalaye
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. laurence.baranes@aphp.fr.|AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France. laurence.baranes@aphp.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Baranes
authors.affiliation: Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. julien.calderaro@aphp.fr.|AP-HP, Hôpitaux Universitaires Henri Mondor, Pathologie, Créteil, F-94010, France. julien.calderaro@aphp.fr.|INSERM Unité U 955, Equipe 18, Créteil, F-94010, France. julien.calderaro@aphp.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Calderaro
authors.affiliation: Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. alexis.laurent@aphp.fr.|INSERM Unité U 955, Equipe 18, Créteil, F-94010, France. alexis.laurent@aphp.fr.|AP-HP, Hôpitaux Universitaires Henri Mondor, Chirurgie hépatique, Créteil, F-94010, France. alexis.laurent@aphp.fr.
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. frederic.pigneur@aphp.fr.
authors.forename: Frederic
authors.initials: F
authors.lastname: Pigneur
authors.affiliation: Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. christophe.duvoux@aphp.fr.|AP-HP, Hôpitaux Universitaires Henri Mondor, Hépatologie, Créteil, F-94010, France. christophe.duvoux@aphp.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
authors.affiliation: Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. daniel.azoulay@aphp.fr.|AP-HP, Hôpitaux Universitaires Henri Mondor, Chirurgie hépatique, Créteil, F-94010, France. daniel.azoulay@aphp.fr.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.affiliation: Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. charlotte.costentin@aphp.fr.|AP-HP, Hôpitaux Universitaires Henri Mondor, Hépatologie, Créteil, F-94010, France. charlotte.costentin@aphp.fr.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Costentin
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. alain.rahmouni@aphp.fr.|Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. alain.rahmouni@aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Rahmouni
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. alain.luciani@aphp.fr.|Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. alain.luciani@aphp.fr.|INSERM Unité U 955, Equipe 18, Créteil, F-94010, France. alain.luciani@aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
mesh_terms: D055011:Ablation Techniques / Q000379:methods; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016461:Chemoembolization, Therapeutic / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D020360:Neoadjuvant Therapy / Q000379:methods; D060787:Neoplasm Grading; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D019275:Radiopharmaceuticals; D000509:alpha-Fetoproteins; D019788:Fluorodeoxyglucose F18