Increased hepatic FDG uptake on PET/CT in hepatic sinusoidal obstructive syndrome.
Imaging features of sinusoidal obstruction syndrome (SOS), an increasingly common drawback of chemotherapy, were evaluated via 18F-fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET/CT).



This retrospective study was approved by our Institutional Review Board, with a waiver of informed consent. FDG PET/CT studies of 35 patients (male, 24; female, 11; median age, 53.2 years) obtained between January, 2005 and December, 2012 were analyzed before and after systemic chemotherapy. Diagnosis of SOS was based on histologic (n=13) or gadoxetic acid-enhanced MRI (n=22) findings. On PET/CT images, ROIs drawn on non-tumorous liver generated mean standardized uptake value (SUVliver). Total lesion glycolysis of liver (TLGliver) was calculated as: SUVliver × CT-derived hepatic volume. Paired t-test was applied to compare changes before and after SOS.



Mean (±standard error [SE]) values of hepatic volume (baseline, 1307.7±46.2 cm3; SOS, 1395.4±41.3 cm3; p=0.004), SUVliver (baseline, 2.08±0.06; SOS, 2.27±0.07; p=0.02), and TLGliver (baseline, 2697.5±114.5; SOS, 3170.2±134.2; p=0.001) significantly increased with development of SOS. In contrast, mean SUVaorta was unchanged (baseline, 1.53±0.04; SOS, 1.50±0.04; p=0.52).



Hepatic FDG uptake on PET/CT intensified after onset of SOS and thus may be an inappropriate reference in this setting, potentially skewing chemotherapeutic responses gauged by lesion-to-liver SUV ratio.
Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.|Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
Honsoul
H
Kim
Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.|Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
Song-Ee
SE
Baek
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
Jieun
J
Moon
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
Yun Ho
YH
Roh
Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Narae
N
Lee
Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Arthur
A
Cho
D000328:Adult; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D019786:Gadolinium DTPA / Q000737:chemistry*; D006504:Hepatic Veno-Occlusive Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D016896:Treatment Outcome
C073590:gadolinium ethoxybenzyl DTPA; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA
syndrome; sinusoidal obstruction syndrome