Predictive value of 18F-fluorodeoxyglucose PET/CT for transarterial chemolipiodolization of hepatocellular carcinoma

Figure 1 Predictive value of parameters on ¹⁸F-fluorodeoxyglucose positron emission tomography. Tsuv_max/Lsuv_mean (C) demonstrated the highest area under curve based on the receiver-operating-characteristic curve analysis compared to Tsuv_max (A), and Tsuv_max/Lsuv_max (B). AUC: Area under curve.

Figure 2 Baseline and follow-up images after treatment of fluorodeoxyglucose uptake according to the Tsuv_max/Lsuv_mean ratio. A: Patient with nodular hepatocellular carcinoma (HCC) (white arrow) based on liver dynamic computed tomography (CT) showed fluorodeoxyglucose (FDG) uptake with a low Tsuv_max/Lsuv_mean ratio (< 1.90) in ¹⁸F-FDG positron emission tomography/CT. After transarterial chemo embolization, this patient showed compact lipiodol uptake (red arrow) on follow-up liver CT; B: Patient with infiltrative type HCC (white arrow) in liver dynamic CT showed FDG uptake with a high Tsuv_max/Lsuv_mean ratio (≥ 1.90). This patient showed faint lipiodol uptake (red arrow) in a follow-up liver CT. The patent with a low standardized uptake value (SUV) ratio showed improved treatment response and survival over the patient with a high SUV ratio (complete response vs stable disease, 782 d vs 167 d, respectively).

Figure 3 Overall survival and time to progression rates according to Tsuv_max/Lsuv_mean level. A: Patients exhibiting low Tsuv_max/Lsuv_mean (< 1.90) survived longer than those with high Tsuv_max/Lsuv_mean (≥ 1.90); B: No significant difference of progression was evident between patients exhibiting low Tsuv_max/Lsuv_mean and those with high Tsuv_max/Lsuv_mean. SUV: Standardized uptake value.