title: Feasibility of Preoperative FDG PET/CT Total Hepatic Glycolysis in the Remnant Liver for the Prediction of Postoperative Liver Function.
abstract: OBJECTIVE
  The objective of our study was to investigate the prognostic value of total glycolysis of the remnant liver, which reflects both metabolic and anatomic liver function, for predicting postoperative hepatic insufficiency.
  
  
  METHODS
  Patients who underwent18F-FDG PET/CT and abdominal CT within 1 month of major hepatectomy were retrospectively analyzed. Total liver volume, remnant liver volume, the ratio of the remnant hepatic volume to the preoperative hepatic volume (RFRHV), and mean standardized uptake value (SUVmean) were measured, and total glycolysis of the remnant liver was calculated. Clinical hepatic function reserve values, including the indocyanine green retention rate at 15 minutes, the model for end-stage liver disease (MELD) score, and aspartate aminotransferase to platelet ratio index (APRI), were calculated. Univariate and multivariate analyses were performed, and an optimal model for predicting hepatic insufficiency was developed. ROC curves were used to compare diagnostic performance.
  
  
  RESULTS
  Of 149 patients, seven patients had hepatic insufficiency. The SUVmeanshowed the highest sensitivity (100%; specificity, 31.7%) for predicting hepatic insufficiency, and total glycolysis of the remnant liver showed the highest specificity (96.5%; sensitivity, 57.1%) for predicting hepatic insufficiency. On multivariate analysis, the odds ratio of APRI (> 5.4) and total glycolysis of the remnant liver (≤ 625.6) was 46.3 and 82.9, respectively, for predicting hepatic insufficiency. On ROC curve analysis, a new model composed of APRI and total glycolysis of the remnant liver showed a higher area under the ROC curve (Az) value (Az= 0.899) than SUVmean(0.659), MELD score (0.618), APRI (0.693), RFRHV (0.797), and remnant liver volume (0.762).
  
  
  CONCLUSIONS
  The total glycolysis of the remnant liver has moderate sensitivity and high specificity for predicting hepatic insufficiency. Combining the total glycolysis of the remnant liver and APRI yielded the best diagnostic performance for predicting hepatic insufficiency.
authors.affiliation: 1 Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Arthur
authors.initials: A
authors.lastname: Cho
authors.affiliation: 2 Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
authors.forename: Yong Eun
authors.initials: YE
authors.lastname: Chung
authors.affiliation: 3 Department of Hepatobiliary Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.affiliation: 3 Department of Hepatobiliary Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Kim
authors.affiliation: 3 Department of Hepatobiliary Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Gi Hong
authors.initials: GH
authors.lastname: Choi
authors.affiliation: 4 Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
authors.affiliation: 2 Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
authors.forename: Myeong-Jin
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006019:Glycolysis; D048550:Hepatic Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D008111:Liver Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011184:Postoperative Period; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; hepatic insufficiency; liver function; total glycolysis