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The role of 18 F‐FDG‐PET imaging for the selection of liver transplantation candidates among hepatocellular carcinoma patients
Author(s) -
Yang Sung Hoon,
Suh KyungSuk,
Lee Hae Won,
Cho EungHo,
Cho Jai Young,
Cho Yong Beom,
Yi NamJoon,
Lee Kuhn Uk
Publication year - 2006
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20861
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , positron emission tomography , nuclear medicine , pet imaging , transplantation , radiology , gastroenterology
Positron emission tomography (PET) using F‐18 fluoro‐2‐deoxy‐d‐glucose ( 18 F‐FDG) is now well established as a noninvasive diagnostic tool for the detection of a variety of malignant tumors. However, in the case of hepatocellular carcinoma (HCC), several investigators have reported controversial conclusions and an inadequate sensitivity for PET (50‐55%). Nevertheless, a high positive rate of 18 F‐FDG accumulation has been reported in patients with high‐grade HCC and in those with markedly elevated alpha‐fetoprotein (AFP) levels. Here, we retrospectively reviewed 38 HCC cases that received liver transplantation (LT) at our center between November 2000 and July 2004 and underwent whole‐body PET imaging. 18 F‐FDG uptake was assessed in the liver, and its prognostic significance was investigated. Of 38 patients enrolled, 13 patients had positive PET scans for a liver tumor. When we analyzed the association between tumor factors and PET+ (greater PET lesion uptake) in the liver, preoperative AFP level and vascular invasion were found to be significantly associated with PET+ ( P = 0.003 and P < 0.001, respectively). However, the association between histological grade and PET+ findings did not reach statistical significant difference ( P = 0.074). Moreover, the 2‐year recurrence‐free survival rate of PET− patients was significantly higher than that of PET+ patients (85.1% vs. 46.1%) ( P = 0.0005). Of 6 PET+ patients who met the Milan criteria, 4 patients (66.7%) had recurrence, but all 20 PET− patients who met the Milan criteria were recurrence free. Thus, PET imaging could be a good preoperative tool for estimating the post‐LT risk of tumor recurrence, because histological grade and vascular invasion cannot be determined preoperatively. Importantly, our results indicate that tumor recurrence can be highly anticipated for PET‐imaging‐positive HCC patients who satisfy the Milan criteria. We advise that PET+ HCC patients be selected cautiously for LT. Liver Transpl, 2006. © 2006 AASLD.