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Importance of 18F-FDG PET/CT to select patients with nonresectable colorectal liver metastases for liver transplantation

Grut, Haralda,d; Revheim, Mona-Elisabetha,d; Line, Pål-Dagb,d; Dueland, Sveinc

Nuclear Medicine Communications: July 2018 - Volume 39 - Issue 7 - p 621–627
doi: 10.1097/MNM.0000000000000843

Objective The aim of this study was to evaluate fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT for the selection of patients with nonresectable colorectal liver metastases (NCLM) for liver transplantation (LT). In the secondary cancer study, we reported an improved 5-year overall survival in patients treated with LT for NCLM (56%) compared with chemotherapy (9%). However, many patients were rejected for LT owing to the detection of extrahepatic disease at preoperative imaging.

Patients and methods 18F-FDG PET/CT and contrast-enhanced computed tomography (ceCT) examinations before tentative LT for NCLM were assessed, and findings contraindicating LT were registered. Maximum, mean and peak standardized uptake values; tumor-to-background ratio; metabolic tumor volume; and total lesion glycolysis were measured and calculated for all liver metastases. Overall survival was calculated by the Kaplan–Meier method.

Results Thirty-two patients excluded by 18F-FDG PET/CT and/or ceCT before tentative LT for NCLM were identified. 18F-FDG PET/CT from 20 of the 32 excluded patients revealed extrahepatic disease. Eight of the other 12 patients had a negative 18F-FDG PET/CT finding but were excluded by ceCT. Ten patients were excluded by 18F-FDG PET/CT only. Four patients were excluded owing to detected malignancy from frozen sections at the start of the intended transplant operation. Tumor-to-background ratio of the liver metastases was significantly higher in patients where 18F-FDG PET/CT detected extrahepatic disease (P=0.03). The median (range) survival after exclusion was 16 (0–52) months.

Conclusion The ability of 18F-FDG PET/CT to detect extrahepatic disease before LT for NCLM is vital to establish LT as a treatment option.

aDepartment of Radiology and Nuclear Medicine

bDepartment of Transplantation Medicine

cDepartment of Oncology, Oslo University Hospital

dInstitute of Clinical Medicine, University of Oslo, Oslo, Norway

Correspondence to Harald Grut, MD, Department of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, 0424 Oslo, Norway Tel: +47 971 08503; fax: +47 221 19366; e-mail:

Received January 24, 2018

Received in revised form March 21, 2018

Accepted March 25, 2018

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