Diagnostic significance of fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography in differentiating Edmondson grade II and III hepatocellular carcinoma
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND Preoperative prognosis assessment of hepatocellular carcinoma (HCC) is crucial, and pathologic grading is a key prognostic determinant that affects patient prognosis. Therefore, accurate determination of pathological grading before surgical intervention is crucial for optimizing treatment strategies and improving prognostic outcomes. AIM To investigate the distinguishing capability of fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT)-derived metabolic parameters between Edmondson grade II and III HCC and to assess their correlation with Ki67 expression levels. METHODS We retrospectively assessed the 18F-FDG PET/CT imaging datasets from 32 patients with solitary HCC, all of whom had pathological confirmation of their diagnosis. Patients were categorized into Edmondson grade II and III groups according to pathological grading criteria. Comparative analyses were conducted on metabolic parameters, including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), tumor-to-normal background ratio (TNR), and tumor-to-blood pool ratio (TBR), between the groups. Further, correlations between these parameters and Ki67 expression were investigated. RESULTS Significant differences were observed in SUVmax, SUVmean, TLG, TNR, and TBR between Edmondson grade II and III HCC groups (P < 0.05), whereas MTV was not significantly different (P = 0.052). The maximum tumor diameter and Ki67 expression percentage significantly varied between the two groups (P < 0.05). SUVmax yielded the largest area under the receiver operating characteristic curve, measuring 0.853 (95% confidence interval: 0.709-0.997, P = 0.001). Using an optimal SUVmax cut-off of 10.95, the sensitivity and specificity for identifying Edmondson grade III HCC were 66.7% and 100%, respectively. Notably, significant positive correlations were identified in terms of SUVmax, SUVmean, TNR, TBR, and the percentage of Ki67 expression (P < 0.01). Conversely, MTV, TLG, and maximum tumor diameter exhibited no significant association with Ki67 expression (P > 0.05). CONCLUSION 18F-FDG PET/CT-derived metabolic parameters, particularly SUVmax, SUVmean, TNR, TBR, and TLG, are valuable in differentiating Edmondson grade II and III HCC, with SUVmax showing the optimal differential diagnostic efficacy. TLG is a three-dimensional volumetric parameter that holds some differential diagnostic potential, but it fails to display a distinct advantage. Moreover, increased 18F-FDG uptake and Ki67 expression in tumor tissue correlate with poorer HCC prognoses, emphasizing their potential role in prognostic assessments.
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414436686