Value of fluorine-18-FDG-PET to monitor hepatocellular carcinoma after interventional therapy.


METHODS Thirty-two tumors in 30 patients with hepatocellular carcinoma (HCC) were studied preoperatively using PET with 18F-labeled 2-fluoro-2-deoxy-D-glucose (FDG) to evaluate the metabolic activity of the lesions after interventional therapy. All patients had received transcatheter arterial chemoembolization therapy using iodized oil (Lipiodol, Laboratoire Guerbet, Alnaysous-Bois, France) before the PET study. The tumors were 2 to 18 cm in diameter. FDG uptake at 48 to 60 min after tracer injection was used to determine the standardized uptake value (SUV). The SUVs of the tumor and nontumor regions of the liver were calculated to obtain the tumor-to-nontumor ratio (SUV ratio). The PET results were compared with the findings of CT and histologic examination. RESULTS The tumors were divided into three types, consisting of those with increased FDG uptake (SUV ratio of 1.07-2.66, Type A, n = 19), similar FDG uptake to the surrounding nontumor region (SUV ratio of 0.77-1.04, Type B, n = 7) and decreased or absent FDG uptake (SUV ratio of 0.13-0.58, Type C, n = 6). In histologic examination, viable HCC tissue remained in all Type A and B tumors, whereas more than 90% necrosis was found in the Type C tumors, indicating that interventional therapy had been effective. These PET findings reflected tumor viability more accurately than the extent of intratumor Lipiodol retention on CT images. CONCLUSION FDG-PET appears to be a valuable method for the assessment of tumor viability after interventional therapy for HCC.


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