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Preoperative Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Prediction of Microvascular Invasion in Small Hepatocellular Carcinoma

Kobayashi, Tomoki MD; Aikata, Hiroshi MD, PhD; Honda, Fumi MD; Nakano, Norihito MD; Nakamura, Yuki MD; Hatooka, Masahiro MD; Morio, Kei MD; Morio, Reona MD; Fukuhara, Takayuki MD; Masaki, Keiichi MD; Nagaoki, Yuko MD, PhD; Kawaoka, Tomokazu MD, PhD; Tsuge, Masataka MD, PhD; Hiramatsu, Akira MD, PhD; Imamura, Michio MD, PhD; Kawakami, Yoshiiku MD, PhD; Ohdan, Hideki MD, PhD; Awai, Kazuo MD, PhD; Chayama, Kazuaki MD, PhD

Journal of Computer Assisted Tomography: July/August 2016 - Volume 40 - Issue 4 - p 524–530
doi: 10.1097/RCT.0000000000000405
Abdominal Imaging

Objectives This study aimed to assess the value of preoperative fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT) for predicting microvascular invasion (MVI) in small hepatocellular carcinoma (HCC).

Methods We retrospectively examined 60 patients who received 18F-FDG PET-CT prior to hepatic resection for small HCC (≤30 mm) with subsequent MVI confirmation by histopathology. The associations between PET-positive status and tumor factors were assessed. Furthermore, independent predictors for MVI and diagnostic utility of each MVI predictor were assessed.

Results Multivariate analysis revealed the presence of MVI as an independent predictor of PET-positive status (P = 0.023). Maximum standardized uptake value (SUVmax) of 3.2 or greater (P = 0.017) and lens culinaris agglutinin a-reactive α-fetoprotein (AFP-L3) 19% or greater (P = 0.010) were independent predictors of MVI. Areas under the receiver operating characteristic curves for SUVmax of 3.2 or greater, AFP-L3 19% or greater, and both factors combined for predicting MVI were 0.712 (0.493-0.932), 0.755 (0.563-0.947), and 0.856 (0.721-0.991), respectively. The sensitivity and specificity for predicting MVI were 77.8% and 74.5% for SUVmax of 3.2 or greater, 66.7% and 84.3% for AFP-L3 19% or greater, and 88.9% and 82.4% for the combination.

Conclusions 18F-FDG PET-CT and AFP-L3 may be useful for predicting MVI in small HCC, and the combination of the 2 factors provided reliable assessment for selection of suitable hepatic resection and liver transplantation candidates.

From the *Department of Gastroenterology and Metabolism, Hiroshima University Hospital; and †Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, ‡Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, and §Liver Research Project Center, Hiroshima University, Hiroshima, Japan.

Received for publication September 20, 2015; accepted November 16, 2015.

Correspondence to: Hiroshi Aikata, MD, PhD, Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan (e-mail:

The scientific guarantor of this publication is K.C. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval and written informed consent were not required because this study is a retrospective analysis of 18F-FDG PET-CT that was performed for clinical purposes.

The authors declare no conflict of interest.

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