Original Article
Copyright ©2009 Baishideng. All rights reserved.
World J Hepatol. Oct 31, 2009; 1(1): 90-97
Published online Oct 31, 2009. doi: 10.4254/wjh.v1.i1.90
Metabolic restaging of hepatocellular carcinoma using whole-body 18F-FDG PET/CT
Long Sun, Yong-Song Guan, Wei-Min Pan, Zuo-Ming Luo, Ji-Hong Wei, Long Zhao, Hua Wu
Long Sun, Wei-Min Pan, Zuo-Ming Luo, Ji-Hong Wei, Long Zhao, Hua Wu, Minnan PET Center and Department of Nuclear Medicine, The First Hospital of Xiamen University, Xiamen 316003, Fujian Province, China
Yong-Song Guan, State Key Laboratory of Biotherapy, West China Medical School, Sichuan University, Gaopeng Street, Keyuan Road 4, Chengdu 610041, Sichuan Province, China
Author contributions: Sun L wrote the paper and organized the figures and patient data; Pan WM, Luo ZM, Zhao L and Wei JH completed patient follow-ups and data collection; Wu H and Guan YS supervised the writing and organization process.
Correspondence to: Hua Wu, MD, Minnan PET Center and Department of Nuclear Medicine, The First Hospital of Xiamen University, Xiamen 316003, Fujian Province, China. wuhua1025@163.com
Telephone: +86-592-2139527 Fax: +86-592-2139527
Received: February 24, 2009
Revised: April 10, 2009
Accepted: April 17, 2009
Published online: October 31, 2009

AIM: To evaluate the ability of 18F-fluorodeoxyglucose positron emission and computed tomography (18F-FDG PET/CT) in restaging of hepatocellular carcinoma (HCC) after treatment.

METHODS: We reviewed a database of the diagnostic performance of 18F-FDG PET/CT scan for patients with HCC following local or regional treatment. The database consisted of 18F-FDG PET/CT information of 21 male and 4 female (age range, 27-81 years; mean age, 51.6 years) patients who had received surgical resection and/or interventional treatments and then underwent 18F-FDG PET/CT scan. All patients had received enhanced CT scan of the liver two weeks before or after the 18F-FDG PET/CT scan. Intrahepatic recurrence and/or extrahepatic metastases were confirmed by histological analysis or clinical and imaging follow-up. The accuracy of 18F-FDG PET/CT study was determined by histopathological results or by clinical and imaging follow-up.

RESULTS: 18F-FDG PET/CT was abnormal in 19 of the 25 (76.0%) patients. In detecting HCC recurrence, 18F-FDG PET/CT scored 17 true positives, 5 true negatives, 2 false positives and 1 false negative. The sensitivity, specificity and accuracy of 18F-FDG PET/CT in detecting HCC recurrence was 89.5%, 83.3% and 88%, respectively. 18F-FDG PET/CT had an impact on management of these patients by settling the problem of an unexplained increase in alpha-fetoprotein after treatment (14 patients), by monitoring response to the treatment and guiding additional regional therapy (12 patients), by identifying extrahepatic metastases (10 patients), by identifying tumor growth or thrombosis in the portal vein (6 patients), or by guiding surgical resection of extrahepatic metastases (2 patients).

CONCLUSION: Our results suggest that whole body 18F-FDG PET/CT may be useful in the early evaluation of residual, intrahepatic recurrent or extrahepatic metastatic lesions and able to provide valuable information for the management of HCC recurrence.

Keywords: 18F-fluorodeoxyglucose, Positron emission tomography/computed tomography, Hepatocellular carcinoma, Surgeon resection, Interventional treatment, Residual lesion, Intrahepatic recurrence, Extrahepatic metastases, Restaging