title: Predictive Value of 18F-FDG PET/CT for Vascular Invasion in Patients With Hepatocellular Carcinoma Before Liver Transplantation.
abstract: BACKGROUND
  Positron emission tomography-computed tomography using F-fluorodeoxyglucose (F-FDG PET/CT) has been widely used in oncology. Vascular invasion of hepatocellular carcinoma (HCC) is associated with a high risk of tumor recurrence and low survival rates after liver transplantation (LT). This retrospective study determined the predictive value of F-FDG PET/CT for vascular invasion in patients with HCC before LT.
  
  
  METHODS
  Sixty-five patients with HCC who underwent F-FDG PET/CT before LT were retrospectively included between January 2010 and July 2012. Volumes of interest (VOIs) were drawn for the tumors and normal liver tissues, and the standardized uptake value (SUV) in each VOI was measured. The maximal SUV (SUVmax) of the tumor, the ratio of tumor SUVmax to normal liver SUVmax (TSUVmax/LSUVmax), and the ratio of tumor SUVmax to normal liver SUVmean (TSUVmax/LSUVmean) were measured. The predictive value of metabolic parameters and conventional prognostic factors were analyzed.
  
  
  RESULTS
  Vascular invasion was pathologically confirmed in 15 (23.08%) of 65 patients. Compared with patients without vascular invasion, patients with vascular invasion exhibited significantly higher serum alpha-fetoprotein (AFP) (P < 0.001), larger tumor size (P = 0.001), higher tumor number (P = 0.017), and higher SUVmax, TSUVmax/LSUVmax ratio, and higher TSUVmax/LSUVmean ratio (P = 0.008, P = 0.002, and P = 0.006, respectively). Univariate analysis revealed that SUVmax, TSUVmax/LSUVmax ratio, and TSUVmax/LSUVmean ratio of FDG PET/CT were significantly associated with vascular invasion in patients with HCC before LT (P = 0.019, P = 0.018, and P = 0.015, respectively). Multivariate analysis revealed that the TSUVmax/LSUVmean ratio of F-FDG PET/CT was a significant predictor of vascular invasion (P = 0.04) and that the TSUVmax/LSUVmax ratio of F-FDG PET/CT was an independent predictor of vascular invasion, although this finding demonstrated borderline statistical significance (P = 0.06) in patients with HCC before LT.
  
  
  CONCLUSIONS
  According to the study results, the TSUVmax/LSUVmean ratio is an independent and significant predictor of vascular invasion, and the TSUVmax/LSUVmax ratio of F-FDG PET/CT is an independent predictor of vascular invasion, which is the main negative outcome after LT. Therefore, FDG PET/CT can provide vital information for determining prognosis and selecting an optimal candidate of LT for HCC.
authors.affiliation: From the *Department of Nuclear Medicine, Show Chwan Memorial Hospital, Changhua; †China Medical University, Taichung; ‡Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung; §Department of Nuclear Medicine, Taoyuan General Hospital, Taoyuan; ∥Department of Biomedical Imaging and Radiological Science, ¶Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, #Department of Surgery, Organ Transplantation Center, **Department of Radiology, ††Management Office for Health Data, and ‡‡College of Medicine, China Medical University, Taichung; and §§Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, People's Republic of China.
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Lin
authors.forename: Chiung-Wei
authors.initials: CW
authors.lastname: Liao
authors.forename: Lu-Yen
authors.initials: LY
authors.lastname: Chu
authors.forename: Kuo-Yang
authors.initials: KY
authors.lastname: Yen
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
authors.forename: Cheng-Nan
authors.initials: CN
authors.lastname: Hsu
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D057234:Preoperative Period; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18