FDG-PET is relatively insensitive for hepatocellular carcinoma. Well-differentiated tumors can have metabolic activity that can be similar to the normal liver parenchyma, resulting in reported sensitivities of at most ~65%. The sensitivity falls to 0% in patients with end-stage liver disease awaiting transplantation.
However, there may be a role for FDG-PET in prognosis, with FDG-avid lesions representing poorly differentiated tumors and poorer prognosis.
The image above shows extensive hepatocellular carcinoma in the liver with a right adrenal metastasis (arrows). The FDG uptake pattern is essentially normal in both the liver and the right adrenal gland.
References
- Ahn SG, Kim SH, Jeon TJ, Cho HJ, Choi SB, Yun MJ, Lee JD, Kim KSJ. The role of preoperative [18F]fluorodeoxyglucose positron emission tomography in predicting early recurrence after curative resection of hepatocellular carcinomas. Gastrointest Surg. 2011 Nov;15(11):2044-52. Epub 2011 Sep 9.
- Hustinx R. PET imaging in assessing gastrointestinal tumors. Radiol Clin North Am. 2004 Nov;42(6):1123-39, ix.
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