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12.06.2018 | Nuclear Medicine | Ausgabe 12/2018

European Radiology 12/2018

Efficacy of contrast-enhanced FDG PET/CT in patients awaiting liver transplantation with rising alpha-fetoprotein after bridge therapy of hepatocellular carcinoma

Zeitschrift:
European Radiology > Ausgabe 12/2018
Autoren:
Rania Refaat, Mohammad Abd Alkhalik Basha, Mohammed Sobhi Hassan, Rasha S. Hussein, Ahmed A. El Sammak, Dena Abd El Aziz El Sammak, Mohamed Hesham Saleh Radwan, Nahla M. Awad, Somaia A. Saad El-Din, Engi Elkholy, Dina R. D. Ibrahim, Shereen A. Saleh, Iman F. Montasser, Hany Said
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00330-018-5425-z) contains supplementary material, which is available to authorized users.

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

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330_2018_5425_MOESM1_ESM.docx
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