Rania Refaat1, Mohammad Abd Alkhalik Basha2, Mohammed Sobhi Hassan1, Rasha S Hussein1, Ahmed A El Sammak3, Dena Abd El Aziz El Sammak3, Mohamed Hesham Saleh Radwan3, Nahla M Awad4, Somaia A Saad El-Din5, Engi Elkholy6, Dina R D Ibrahim6, Shereen A Saleh7, Iman F Montasser8, Hany Said9. 1. Department of Radiodiagnosis, Ain Shams University, Cairo, Egypt. 2. Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt. drmohammad_basha@yahoo.com. 3. Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt. 4. Early Cancer Detection Unit, Ain Shams University Hospitals, Cairo, Egypt. 5. Department of Pathology, Ain Shams University, Cairo, Egypt. 6. Department of Clinical Oncology, Ain Shams University, Cairo, Egypt. 7. Department of Internal Medicine, Gastroenterology and Hepatology Unit, Ain Shams University, Cairo, Egypt. 8. Department of Tropical Medicine, HCC Unit, Ain Shams University, Cairo, Egypt. 9. Department of General Surgery HPB, and Liver Transplantation, Ain Shams Center for Organ Transplantation, Ain Shams University, Cairo, Egypt.
Abstract
OBJECTIVE: To assess the diagnostic accuracy and illustrate positive findings of contrast-enhanced fluorine-18 fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) image in patients awaiting liver transplantation (LT) with rising alpha-fetoprotein (AFP) after bridge therapy of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This prospective study included 100 patients who were waiting for LT and who previously underwent locoregional therapy (LRT) of HCC. These patients had rising AFP levels on a routine follow-up examination awaiting LT. All patients underwent a contrast-enhanced 18F-FDG PET/CT examination. We calculated for each patient the maximum standardised uptake value (SUVmax) of the tumour and the ratio of the tumoral SUVmax to the normal-liver SUVmax. The diagnostic accuracy and positive contrast-enhanced findings of 18F-FDG PET/CT were established by histopathology and clinical and imaging follow-up as the reference standards. RESULTS: Contrast-enhanced 18F-FDG PET/CT detected tumour relapse in 78 patients (13 patients had intrahepatic lesions, 10 patients had extrahepatic metastases and 55 patients with combined lesions). The sensitivity, specificity and accuracy values of contrast-enhanced 18F-FDG PET/CT examination in the detection of HCC recurrence were 92.8%, 94.1% and 93%, respectively. A significant correlation was found between the AFP level and SUVmax ratio (r = 0.2283; p = 0.0224). The best threshold for 18F-FDG PET positivity was >1.21. CONCLUSION: Contrast-enhanced 18F-FDG PET/CT is a valuable tool for the detection of intrahepatic HCC recurrence or extrahepatic metastasis following rising AFP levels after LRT of HCC, and should be incorporated during routine workup awaiting LT. KEY POINTS: • 18F-FDG PET/CT is a valuable tool for the detection of HCC recurrence • 18 F-FDG PET/CT should be incorporated during routine workup awaiting liver transplantation • Significant correlation was found between AFP level and SUVmax ratio • The best threshold for 18 F-FDG PET positivity was >1.21 • The ideal cut-off value for AFP was >202.
OBJECTIVE: To assess the diagnostic accuracy and illustrate positive findings of contrast-enhanced fluorine-18 fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) image in patients awaiting liver transplantation (LT) with rising alpha-fetoprotein (AFP) after bridge therapy of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This prospective study included 100 patients who were waiting for LT and who previously underwent locoregional therapy (LRT) of HCC. These patients had rising AFP levels on a routine follow-up examination awaiting LT. All patients underwent a contrast-enhanced 18F-FDG PET/CT examination. We calculated for each patient the maximum standardised uptake value (SUVmax) of the tumour and the ratio of the tumoral SUVmax to the normal-liver SUVmax. The diagnostic accuracy and positive contrast-enhanced findings of 18F-FDG PET/CT were established by histopathology and clinical and imaging follow-up as the reference standards. RESULTS: Contrast-enhanced 18F-FDG PET/CT detected tumour relapse in 78 patients (13 patients had intrahepatic lesions, 10 patients had extrahepatic metastases and 55 patients with combined lesions). The sensitivity, specificity and accuracy values of contrast-enhanced 18F-FDG PET/CT examination in the detection of HCC recurrence were 92.8%, 94.1% and 93%, respectively. A significant correlation was found between the AFP level and SUVmax ratio (r = 0.2283; p = 0.0224). The best threshold for 18F-FDG PET positivity was >1.21. CONCLUSION: Contrast-enhanced 18F-FDG PET/CT is a valuable tool for the detection of intrahepatic HCC recurrence or extrahepatic metastasis following rising AFP levels after LRT of HCC, and should be incorporated during routine workup awaiting LT. KEY POINTS: • 18F-FDG PET/CT is a valuable tool for the detection of HCC recurrence • 18 F-FDG PET/CT should be incorporated during routine workup awaiting liver transplantation • Significant correlation was found between AFP level and SUVmax ratio • The best threshold for 18 F-FDG PET positivity was >1.21 • The ideal cut-off value for AFP was >202.
Authors: Myeong Jun Song; Si Hyun Bae; Sung Won Lee; Do Sun Song; Hee Yeon Kim; Ie Ryung Yoo; Joon-Il Choi; Young June Lee; Ho Jong Chun; Hae Giu Lee; Jong Young Choi; Seung Kew Yoon Journal: Eur J Nucl Med Mol Imaging Date: 2013-02-22 Impact factor: 9.236
Authors: A Kornberg; M Freesmeyer; E Bärthel; K Jandt; K Katenkamp; J Steenbeck; A Sappler; O Habrecht; D Gottschild; U Settmacher Journal: Am J Transplant Date: 2009-02-03 Impact factor: 8.086
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