title: Low Utility of Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography for Detecting Hepatocellular Carcinoma in Patients Before Liver Transplantation.
abstract: OBJECTIVE
  Our program routinely used fluorodeoxyglucose-positron emission tomography/computed tomography as part of the liver transplant evaluation of patients with hepatocellular carcinoma. The aim of this study was to evaluate the role of this imaging modality in the pretransplant work-up.
  
  
  METHODS
  This was a retrospective chart review of our liver transplant database from January 2011 to December 2014 for all patients with hepatocellular carcinoma who underwent a liver transplant. Collected data included age, sex, cause of liver disease, imaging modality, fluorodeoxyglucose-positron emission tomography/computed tomography results, explant tissue analysis, type of transplant, and transplant outcome.
  
  
  RESULTS
  During the study period, 275 liver transplants were performed. Fifty-three patients had hepatocellular carcinoma; 41 underwent fluorodeoxyglucose-positron emission tomography/computed tomography. Twenty-nine patients underwent living-donor liver transplant, and 12 patients underwent deceased-donor liver transplant. One of the 41 patients with negative FDG-imaging results had no evidence of hepatocellular carcinoma in the explant and was excluded from the study. The patients' average age was 58 years (range, 22-72 y), and 28 patients were men. The cause of liver disease was hepatitis C virus in 24 patients, cryptogenic cirrhosis in 12 patients, and hepatitis B virus in 5 patients. One patient had no hepatocellular carcinoma on explants and was excluded from the study. Twenty-five patients had hepatocellular carcinoma that met the Milan criteria, 7 were within the UCSF (University of California, San Francisco) criteria, and 8 exceeded the UCSF criteria. Of the 40 patients, 11 had positive fluorodeoxyglucose-positron emission tomography/computed tomography results (27.5%) with evidence of hepatocellular carcinoma in the explant; the remaining 29 patients (72.5%) had negative results. The fluorodeoxyglucose-positron emission tomography/computed tomography results were positive in 16% (4 of 21) of patients who met the Milan criteria, 28% (2 of 7) of patients who met the UCSF criteria and 62% (5 of 8) of patients who exceeded the UCSF criteria.
  
  
  CONCLUSIONS
  Fluorodeoxyglucose-positron emission tomography/computed tomography has a low degree of use in patients with hepatocellular carcinoma that falls within the Milan criteria and should not be routinely used as part of the liver transplant work-up.
authors.affiliation: Department of Liver & Small Bowel Transplantation & Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Alotaibi
authors.forename: Monther
authors.initials: M
authors.lastname: Kabbani
authors.forename: Faisal
authors.initials: F
authors.lastname: Abaalkhail
authors.forename: Alicia
authors.initials: A
authors.lastname: Chorley
authors.forename: Hany
authors.initials: H
authors.lastname: Elbeshbeshy
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-Hamoudi
authors.forename: Saleh
authors.initials: S
authors.lastname: Alabbad
authors.forename: Markus U
authors.initials: MU
authors.lastname: Boehnert
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alsofayan
authors.forename: Wael
authors.initials: W
authors.lastname: Al-Kattan
authors.forename: Baderaldeen
authors.initials: B
authors.lastname: Ahmed
authors.forename: Dieter
authors.initials: D
authors.lastname: Broering
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al Sebayel
authors.forename: Hussien
authors.initials: H
authors.lastname: Elsiesy
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000821:virology; D016208:Databases, Factual; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18