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Background   18 F-fluorodeoxyglucose ( 18 F-FDG) uptake in hepatocellular carcinoma (HCC) is significantly associated with early recurrence and survival after curative surgical resection. However, there are no reports regarding the relationship between  18 F-FDG uptake and outcomes after radiofrequency ablation (RFA). A prospective cohort study was conducted to evaluate the prognostic value of  18 F-FDG positron emission tomography (PET) in HCC patients after RFA.    Methods  A total of 121 consecutive patients with primary HCC (≤3 tumors, of diameter ≤ 3 cm) without vascular invasion on imaging were examined by  18 F-FDG-PET computed tomography prior to RFA. An HCC with a component of  18 F-FDG uptake visibly stronger than that of surrounding liver was defined as  18 F-FDG-PET positive.    Results  The median follow-up period was 1267 days. There were 110  18 F-FDG-PET negative and 11 positive tumors. The cumulative 1-year recurrence rates in the  18 F-FDG negative and positive groups were 30 and 64% ( P =  0.017), respectively, and cumulative 1-year metastatic recurrence rates were 6 and 36% ( P <  0.001), respectively. The cumulative 5-year survival rates were 88 and 22% ( P <  0.001), respectively. Multivariate analysis revealed  18 F-FDG-PET positivity and tumor size as independent factors related to metastatic recurrence and survival after RFA.    Conclusions   18 F-FDG-PET positivity was significantly associated with outcomes after RFA. RFA should not be readily selected as the first-line treatment for small HCC that includes a component of visually strong  18 F-FDG uptake.

cancer imaging

Prognostic value of 18F-fluorodeoxyglucose positron emission tomography in patients with small hepatocellular carcinoma treated by radiofrequency ablation