Abstract
Background: Microvascular invasion (MVI) is very important in the evaluation of hepatocellular carcinoma (HCC),but diagnosis is determined by postoperative pathology; thus, preoperative non-invasive methods will play an active role. The purpose of this study was to assess the performance of metabolic parameters of preoperative 18F-fluorodeoxyglucose positron emission tomography/computerized tomography (18F-FDG PET/CT) in the prediction of MVI and postoperative recurrence in primary hepatocellular carcinoma.Methods: We retrospectively collected 72 patients with HCC who have performed 18F-FDG PET/CT scan before partial hepatectomy between 2016 and 2019. We used both normal liver tissue and inferior vena cava as the reference background, and combined with clinicopathological features, 18F-FDG PET/CT metabolic and volumetric indices to predict MVI and postoperative recurrence of primary HCC before surgery.Results: Twenty-one of the 72 patients recurred, in recurrent cases showed higher maximum standard uptake value (SUVmax), TNR (ratio of tumor SUVmax to mean SUV [SUVmean] of the background tissue), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) than nonrecurrence cases(p<0.001). All 18F-FDG PET metabolic and volumetric indices for predicting postoperative HCC recurrence were significant on receiver-operating-characteristic (ROC) curve analyses (p<0.05). TNRIVC, TNRNL, MTV, TLGIVC, and TLGNL were significant factors for predicting MVI in HCC (p<0.05). On multivariate analyses, MVI, SUVmax, TNRIVC, TNRNL, MTV, TLGIVC, and TLGNL(p<0.05) are independent risk factors for predicting postoperative HCC recurrence. TNRIVC is the most relevant PET/CT parameter for predicting MVI in HCC, and MTV is the most valuable for predicting postoperative HCC recurrence. Moreover, the PET/CT parameters are more accurate for prognosis with inferior vena cava as a reference background than with normal liver tissue.Conclusion: 18F-FDG PET/CT metabolic and volumetric indices are effective predictors, and could non-invasively provide more comprehensive predictive information on MVI and postoperative recurrence of primary HCC before surgery.
Septic and tumor thrombosis caught by inferior vena cava filters and demonstrated on FDG PET/CT