The application value of positron emission tomography-CT in clinical assessment of pre- and post-operations of liver transplantation in patients with hepatocellular carcinoma

Objective: To assess the clinical value of 18-fluorodeoxy glucose (18F-FDG) positron emission tomography-computer tomography (PET-CT) in preoperative evaluation of hepatocellular carcinoma patients awaiting liver transplantation and in early discovery of the recurrent focus in patients after liver transplantation. Methods: This was a retrospective study of 21 patients (34 times) with hepatocellular carcinoma who underwent 18F-FDG PET-CT. The clinical materials of preoperation and postoperation were analyzed with 18F-FDG PET-CT images. A total of 12 18F-FDG PET-CT examinations in 10 patients were done preoperatively. Among them, the purpose of 8 18F-FDG PET-CT examinations in 8 patients was preoperative evaluation, and the purpose of 4 18F-FDG PET-CT examinations in 2 patients was to define the deactivation and metastasis of hepatoma in the whole body after adjuvant therapy. 22 18F-FDG PET-CT examinations in 11 postoperative patients was performed to determine the recurrence and metastasis. The average interval between postoperative PET-CT examination and operations was 8.68 months. Results: (1) PET examinations in 2 of the 8 patients for preoperative evaluations showed no evidence of recurrence and/or metastasis, so they accepted the liver transplantations as scheduled; while 18F-FDG PET-CT examinations in 6 of the 8 patients discovered distinct extents of metastasis, 2 of them accepted the liver transplantations because of the metastasis were situated inside the operating field, but 4 of them gave up the operation because of the different extents of distant metastasis and were shifted to interventional therapy and other treatments. (2) 22 18F-FDG PET-CT examinations in 11 patients were studied after the liver transp lactations. Among them, 2 patients were discovered no focus of metastasis, 1 patient was detected to have mycotic brain abscess, and 4 patients showed recurrence in the grafted liver. In addition, bolts of malignancy in the hepatic veins of double lobes and in the inferior vena cava, lungmetastasis, metastasis in lymph nodes, osseous metastasis, spleen metastasis, parietal pleura metastasis, and metastasis of intervertebral foramen at thoracic vertebra were revealed. Conclusion: PET-CT proved to have significant accuracy in assessing tumor-node-metastasis system staging. Two significant advantages of 18F-FDG PET-CT were the general scan of whole body and hypersensitive manifestation to carcinoma, and these diagnostic advantages result in the change of tumor staging and therapic planning in a substantial number of patients. (authors)