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Predictability of preoperative 18F-FDG PET for histopathological differentiation and early recurrence of primary malignant intrahepatic tumors

Song, Jeong-Yeop; Lee, Yun Nah; Kim, Young Seok; Kim, Sang Gyune; Jin, Soo Ji; Park, Jung Mi; Choi, Gyu Seong; Chung, Jun Chul; Lee, Min Hee; Cho, Youn Hee; Choi, Moon Han; Kim, Dong Choon; Choi, Hyun Jong; Moon, Jong Ho; Lee, Se Hwan; Jeong, Seung Won; Jang, Jae Young; Kim, Hong Soo; Kim, Boo Sung

Nuclear Medicine Communications: April 2015 - Volume 36 - Issue 4 - p 319–327
doi: 10.1097/MNM.0000000000000254

Objective The limited studies with 18F-fluorodeoxyglucose (18F-FDG)-PET reported results and interpretations that differed between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHCC). We investigated the correlation between preoperative PET results and postoperative prognosis, including early (time-to-recurrence<6 months) tumor recurrence, and histopathological tumor differentiation in patients who had undergone surgery for primary malignant intrahepatic tumors, including HCC and IHCC.

Materials and methods We retrospectively reviewed 357 patients who had undergone curative surgery for malignant hepatic tumors, including primary HCC or IHCC, other than Klatskin tumors at a tertiary academic hospital between January 2005 and June 2012. All patients had undergone an 18F-FDG PET/computed tomography scan preoperatively and the maximum standardized uptake value of the tumor (maxSUVtumor) and the tumor-to-nontumor SUV ratio (TNR) were calculated from 18F-FDG uptake. Histopathological differentiation grading was confirmed postoperatively.

Results Among the patients, 115 cases with primary malignant intrahepatic tumors fulfilled the inclusion criteria. On univariate analysis, preoperative maxSUVtumor and TNR showed a correlation with the overall and early tumor recurrence of HCC, but only maxSUVtumor was associated with overall and early recurrence of IHCC (P<0.05). When considering postoperative histopathological differentiation, a correlation between maxSUVtumor and TNR with HCC and between maxSUVtumor and IHCC was found (P<0.05). However, on multivariate analysis, only early recurrence was associated with TNR in HCC and with maxSUVtumor in IHCC.

Conclusion A preoperative 18F-FDG PET scan can be considered a useful reference for postoperative tumor recurrence and histopathological differentiation in cases of primary malignant intrahepatic tumors. 18F-FDG PET scan results should be interpreted separately for malignant liver tumors.

Departments of aInternal Medicine

bNuclear Medicine



eRadiology, Digestive Disease Center and Research Institute, Soon Chun Hyang University Hospital Bucheon, Soon Chun Hyang University College of Medicine, Bucheon, Korea

Correspondence to Young Seok Kim, MD, PhD, Department of Internal Medicine, Digestive Disease Center and Research Institute, Soon Chun Hyang University Hospital Bucheon, Soon Chun Hyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea Tel: +82 32 621 6546; fax: +82 32 621 5080; e-mail:

Received August 10, 2014

Received in revised form November 16, 2014

Accepted November 21, 2014

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