FDG PET/CT early dynamic blood flow and late standardized uptake value determination in hepatocellular carcinoma

Hanna Bernstine, Marius Braun, Nikolay Yefremov, Yechiel Lamash, Raz Carmi, Dorit Stern, Adam Steinmetz, Jacob Sosna, David Groshar*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Purpose: To prospectively determine whether fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography(PET)/ computed tomography(CT) early dynamic blood flow estimates could be used to discriminate hepatocellular carcinoma (HCC) from background liver and to characterize HCC in patients with and those without angioinvasion; and to evaluate the association between blood flow measures at FDG PET/CT with metabolism in HCCs. Materials and Methods: Institutional review board approval and written informed consent were obtained for this prospective study. Twenty-one consecutive patients (mean age, 65 years) with 30 established HCCs (mean size, 5.5 cm; seven lesions in five patients with angioinvasion) underwent a blood flow study with an FDG dynamic scan divided into 18 sequences of 5 seconds each and a standard PET/CT scan. On the dynamic study, three independent operators obtained volumes of interest (VOIs) for which three blood flow estimates were calculated (hepatic perfusion index [HPI], time to peak [TTP], and peak intensity [PI]). On the late study, a VOI was placed on the fused scan for each HCC, and maximum standardized uptake value(SUV max) was obtained. By using a mixed-effects model analysis, comparison of blood flow estimates between HCC with and that without angioinvasion and background liver was performed. The association between blood flow estimates and SUV max was also assessed. Results: HPI and TTP showed better performance than did SUVmax for discriminating HCC and background liver (areas under receiver operating characteristic curve: 0.96, 0.95, and 0.83, respectively; P<.05). HPI was higher in HCC in patients with angioinvasion (0.91 ± 0.15 [standard deviation]) than in those without angioinvasion (0.80 ± 0.18; P =.03). There was no difference in SUVmax between HCC in patients with and those without angioinvasion (7.8 ± 2.9 vs 6.3 ± 3.4; P =.85). No clear association was found between HPI, PI, or TTP and SUVmax (P =.49,.77, and.91, respectively). Conclusion: Early dynamic blood flow FDG PET/CT may be used to help discriminate and characterize HCC tumors.

Original languageAmerican English
Pages (from-to)503-510
Number of pages8
Issue number2
StatePublished - Aug 2011
Externally publishedYes


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