Preoperative prediction of microvascular invasion of hepatocellular carcinoma using 18F-FDG PET/CT: a multicenter retrospective cohort study

  • Seung Hyup Hyun
  • Jae Seon Eo
  • Bong-Il Song
  • Jeong Won Lee
  • Sae Jung Na
  • Il Ki Hong
  • Jin Kyoung Oh
  • Yong An Chung
  • Tae-Sung Kim
  • Mijin Yun
Original Article



The aim of this study was to assess the potential of tumor 18F-fluorodeoxyglucose (FDG) avidity as a preoperative imaging biomarker for the prediction of microvascular invasion (MVI) of hepatocellular carcinoma (HCC).


One hundred and fifty-eight patients diagnosed with Barcelona Clinic Liver Cancer stages 0 or A HCC (median age, 57 years; interquartile range, 50–64 years) who underwent 18F-FDG positron emission tomography with computed tomography (PET/CT) before curative surgery at seven university hospitals were included. Tumor FDG avidity was measured by tumor-to-normal liver standardized uptake value ratio (TLR) of the primary tumor on FDG PET/CT imaging. Logistic regression analysis was performed to identify significant parameters associated with MVI. The predictive performance of TLR and other clinical variables was assessed using receiver operating characteristic (ROC) curve analysis.


MVI was present in 76 of 158 patients with HCCs (48.1%). Multivariable logistic regression analysis revealed that TLR, serum alpha-fetoprotein (AFP) level, and tumor size were significantly associated with the presence of MVI (P < 0.001). Multinodularity was not significantly associated with MVI (P = 0.563). The area under the ROC curve (AUC) for predicting the presence of MVI was best with TLR (AUC = 0.704), followed by tumor size (AUC = 0.685) and AFP (AUC = 0.670). We were able to build an improved prediction model combining TLR, tumor size, and AFP by using multivariable logistic regression modeling (AUC = 0.756).


Tumor FDG avidity measured by TLR on FDG PET/CT is a preoperative imaging biomarker for the prediction of MVI in patients with HCC.


FDG PET/CT Hepatocellular carcinoma Standardized uptake value Microvascular invasion Multicenter trial 



This research was supported by the Korean Society of Nuclear Medicine Clinical Trial Network (KSNM CTN) working group funded by the Korean Society of Nuclear Medicine (KSNM-CTN-2014-02-1), the Korea University Guro Hospital Grant (O1700461), and the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No. 2014R1A5A2010008).


This research was supported by the Korean Society of Nuclear Medicine Clinical Trial Network (KSNM CTN) working group funded by the Korean Society of Nuclear Medicine (KSNM-CTN-2014-02-1), the Korea University Guro Hospital Grant (O1700461), and the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No. 2014R1A5A2010008).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Written informed consent was waived.

Supplementary material

259_2017_3880_MOESM1_ESM.docx (2.1 mb)
ESM 1 (DOCX 2138 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Seung Hyup Hyun
    • 1
  • Jae Seon Eo
    • 2
  • Bong-Il Song
    • 3
  • Jeong Won Lee
    • 4
  • Sae Jung Na
    • 5
  • Il Ki Hong
    • 6
  • Jin Kyoung Oh
    • 7
  • Yong An Chung
    • 7
  • Tae-Sung Kim
    • 8
  • Mijin Yun
    • 9
  1. 1.Department of Nuclear Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  2. 2.Department of Nuclear Medicine, Korea University Guro HospitalKorea University College of MedicineSeoulSouth Korea
  3. 3.Department of Nuclear Medicine, Dongsan Medical CenterKeimyung University School of MedicineDaeguSouth Korea
  4. 4.Department of Nuclear Medicine, International St. Mary’s HospitalCatholic Kwandong University College of MedicineIncheonSouth Korea
  5. 5.Department of Nuclear Medicine, Uijeongbu St. Mary’s HospitalThe Catholic University of KoreaSeoulSouth Korea
  6. 6.Department of Nuclear Medicine, Kyung Hee University Hospital, School of MedicineKyung Hee UniversitySeoulSouth Korea
  7. 7.Department of Nuclear Medicine, Incheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaIncheonSouth Korea
  8. 8.Department of Nuclear Medicine, Research Institute and HospitalNational Cancer CenterGoyangSouth Korea
  9. 9.Department of Nuclear MedicineYonsei University College of MedicineSeoulSouth Korea

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