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01-12-2018 | Nuclear Medicine

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

Authors: 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

Published in: European Radiology | Issue 12/2018

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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Title: Efficacy of contrast-enhanced FDG PET/CT in patients awaiting liver transplantation with rising alpha-fetoprotein after bridge therapy of hepatocellular carcinoma
Authors: 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
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 12/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5425-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Objective

Materials and methods

Results

Conclusion

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusion

Key Points

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