Patlak Reconstruction Using Dynamic 18F-FDG PET Imaging for Evaluation of Malignant Liver Tumors

Abstract

Purpose of the Report The aim of this study was to explore the different patterns of dynamic whole-body (D-WB) FDG PET/CT parameters among liver malignancy types as potential diagnostic clues and investigate the association between static and dynamic PET/CT parameters for each tumor histology. Patients and Methods Seventy-one patients with intrahepatic cholangiocarcinoma (ICC), metastatic liver tumor (MLT), or hepatocellular carcinoma (HCC) who underwent D-WB and static dual-time-point FDG PET/CT were enrolled. We obtained Pearson correlation coefficients between the metabolic rate of FDG (MRFDG; mg/min/ 100ml) or distribution volume of free FDG (DVFDG, %) and static PET/CT parameters. We compared MRFDG and DVFDG values by tumor type and performed receiver operating characteristic analyses for MRFDG and static images. Results A total of 12 ICC, 116 MLT, and 36 HCC lesions were analyzed. MRFDG and DVFDG showed excellent correlation with early (SUVe) and delayed SUVmax (SUVd) (r = 0.71~0.97), but DVFDG in the HCC lesions did not (r = 0.62 and 0.69 for SUVe and SUVd, respectively) (P < 0.001 for all). HCC lesions showed significantly lower MRFDG (2.43 ± 1.98) and DVFDG (139.95 ± 62.58) than ICC (5.02 ± 3.56, 207.06 ± 97.13) and MLT lesions (4.51 ± 2.47, 180.13 ± 75.58) (P < 0.01 for all). The optimal MRFDG could differentiate HCC from ICC and MLT with areas under the curve of 0.84 and 0.80, respectively. Metastatic liver tumor lesions showed the widest distribution of MRFDG and DVFDG values but with no significant difference among most primary sites. Conclusions MRFDG was strongly correlated with SUVmax in the 3 malignancies and showed utility for differentiating HCC from ICC and MLT. Each tumor type has a different glucose metabolism, and D-WB FDG PET/CT imaging has the potential to visualize those differences.