Skip to main content
SpringerLink
Log in

Heterogeneity of intrahepatic fat distribution determined by 18F-FDG PET and CT

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objectives

Hepatic steatosis is common but less is known of the heterogeneity of hepatic fat distribution and its clinical significance. Our objective was to measure the regional variabilities within the liver of standardised uptake values (SUV) as potential markers of hepatic fat distribution heterogeneity.

Methods

Twenty-four patients having routine, clinically indicated PET/CT with 18F-FDG and a wide range of fatty liver severity were selected. Maximum SUV (SUVmax), average SUV (SUVave), both calculated using lean body mass, and CT density were measured in 12 × 2-cm diameter ROIs in each patient. SUVave was also measured over the left ventricular cavity (SUVLV). Mean values of SUV indices, their ratios with SUVLV, and CT density in the 12 ROIs were calculated. Regional variabilities of SUV indices were expressed as coefficients of variation (CV; standard deviation/mean). Body mass index (BMI) was estimated from height and body weight, and %body fat and lean body mass from height, weight and gender.

Results

Mean SUVmax/SUVave correlated significantly with mean CT density (r = −0.51; p < 0.02). In contrast, mean SUVmax, mean SUVave and their ratios with SUVLV showed no correlation with CT density. Mean CT density correlated with weight (r = −0.59; p < 0.005), BMI (r = −0.57; p < 0.01) and %body fat (r = −0.49; p < 0.02). Corresponding correlation coefficients for mean SUVmax/SUVave were 0.74 (p < 0.001), 0.65 (p < 0.001) and 0.46 (p < 0.03). In contrast, mean SUVmax, mean SUVave and their ratios with SUVLV showed no correlation with BMI, weight and %body fat. The CV of SUVmax/SUVave (r = −0.67; p < 0.001), but not the CVs of SUVmax or SUVave, correlated with mean CT density.

Conclusions

SUVmax/SUVave and CT density are markers of hepatic steatosis. The regional variability of SUVmax/SUVave may be a marker of hepatic fat distribution heterogeneity. The novel concept is introduced that hepatic fat distribution heterogeneity may be a marker of hepatic pathology and of clinical value, and deserves further exploration with texture analysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Anstee QM, McPherson S, Day CP. How big a problem is non-alcoholic fatty liver disease? Br Med J. 2011;343:d3897.

    Article  Google Scholar 

  2. Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124–31.

    Article  PubMed  Google Scholar 

  3. Bohte AE, van Werven JR, Bipat S, Stoker J. The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis. Eur Radiol. 2011;21:87–97.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Agopian VG, Kaldas FM, Hong JC, Whittaker M, Holt C, Rana A, et al. Liver transplantation for non-alcoholic steatohepatitis: the new epidemic. Ann Surg. 2012;256:624–33.

    Article  PubMed  Google Scholar 

  5. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011;43:617–49.

    Article  PubMed  Google Scholar 

  6. Bural GG, Torigian DA, Burke A, Houseni M, Alkhawaldeh K, Cucchiara A, et al. Quantitative assessment of the hepatic metabolic volume product in patients with diffuse hepatic steatosis and normal controls through use of FDG-PET and MR imaging: a novel concept. Mol Imaging Biol. 2010;12:233–9.

    Article  PubMed  Google Scholar 

  7. Abikhzer G, Alabed YZ, Azoulay L, Assayag J, Rush C. Altered hepatic metabolic activity in patients with hepatic steatosis on FDGPET/CT. Am J Roentgenol. 2011;196:176–80.

    Article  Google Scholar 

  8. Lin CY, Lin WY, Lin CC, Shih CM, Jeng LB, Kao CH. The negative impact of fatty liver on maximum standard uptake value of liver on FDG PET. Clin Imaging. 2011;35:437–41.

    Article  PubMed  Google Scholar 

  9. Abele JT, Fung CI. Effect of hepatic steatosis on liver FDG uptake measured in mean standard uptake values. Radiology. 2010;254:917–24.

    Article  PubMed  Google Scholar 

  10. Keramida G, Potts J, Bush J, Dizdarevic S, Peters AM. Hepatic steatosis is associated with increased hepatic FDG uptake. Eur J Radiol. 2014;83:751–5.

    Article  PubMed  Google Scholar 

  11. Keramida G, Potts J, Bush J, Verma S, Dizdarevic S, Peters AM. Accumulation of 18F-fluorodeoxyglucose in the liver in hepatic steatosis. AJR Am J Roentgenol. 2014;203:643–8.

    Article  PubMed  Google Scholar 

  12. Ricci C, Longo R, Gioulis E, Bosco M, Pollesello P, Masutti F, et al. Noninvasive in vivo quantitative assessment of fat content in human liver. J Hepatol. 1997;27:108–13.

    Article  CAS  PubMed  Google Scholar 

  13. Sugawara Y, Zasadny KR, Neuhoff AW, Wahl RL. Re-evaluation of the standardized uptake value for FDG: variations with body weight and methods for correction. Radiology. 1999;213:521–5.

    Article  CAS  PubMed  Google Scholar 

  14. Keramida G Hunter J, Dizdarevic S, Peters AM. The appropriate whole body index on which to base standard uptake value in 2-deoxy-2-[18F]fluoro-d-glucose PET. Br J Radiol (in press).

  15. Boyce CJ, Pickhardt PJ, Kim DH, Taylor AJ, Winter TC, Bruce RJ, et al. Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT. Am J Roentgenol. 2010;194:623–8.

    Article  Google Scholar 

  16. Zeb I, Li D, Nasir K, Katz R, Larijani VN, Budoff MJ. Computed tomography scans in the evaluation of fatty liver disease in a population based study: the multi-ethnic study of atherosclerosis. Acad Radiol. 2012;19:811–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Decarie PO, Lepanto L, Billiard JS, Olivié D, Murphy-Lavallée J, Kauffmann C, et al. Fatty liver deposition and sparing: a pictorial review. Insights Imaging. 2011;2:533–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Boer P. Estimated lean body mass as an index for normalization of body fluid volumes in man. Am J Physiol. 1984;247:F632–5.

    CAS  PubMed  Google Scholar 

  19. Layer G, Zuna I, Lorenz A, Zerban H, Haberkorn U, Bannasch P, et al. Computerized ultrasound B-scan texture analysis of experimental diffuse parenchymal liver disease: correlation with histopathology and tissue composition. J Clin Ultrasound. 1991;19:193–201.

    Article  CAS  PubMed  Google Scholar 

  20. House MJ, Bangma SJ, Thomas M, Gan EK, Ayonrinde OT, Adams LA, et al. Texture-based classification of liver fibrosis using MRI. J Mag Res Imaging. 2015;41:322–8.

    Article  Google Scholar 

  21. Green LA, Gambhir SS, Srinivasan A, Banerjee PK, Hoh CK, Cherry SR, et al. Noninvasive methods for quantitating blood time-activity curves from mouse PET images obtained with fluorine-18-fluorodeoxyglucose. J Nucl Med. 1998;39:729–34.

    CAS  PubMed  Google Scholar 

  22. Keramida G, Dizdarevic S, Bush J, Peters AM. Quantification of tumour 18F-FDG uptake: normalise to blood glucose or scale to liver uptake? Eur Radiol (in press).

  23. Keramida G, Peters AM. FDG accumulation is increased in hepatic steatosis. J Nucl Med 2015; 56 (suppl 3):412P (abstract).

  24. Liu G, Li Y, Hu P, Cheng D, Shi H. The combined effects of serum lipids, BMI, and fatty liver on 18F-FDG uptake in the liver in a large population from China: an 18F-FDG-PET/CT study. Nucl Med Commun. 2015;36:709–16.

    Article  PubMed  Google Scholar 

  25. Erselcan T, Turgut B, Dogan D, Ozdemir S. Lean body mass-based standardized uptake value, derived from a predictive equation, might be misleading in PET studies. Eur J Nucl Med. 2002;29:1630–8.

    Article  Google Scholar 

  26. Mir AH, Hanmandlu M, Tandon SN. Texture analysis of CT-images for early detection of liver malignancy. Biomed Sci Instrum. 1995;31:213–7.

    CAS  PubMed  Google Scholar 

  27. Chicklore S, Goh V, Siddique M, Roy A, Marsden PK, Cook GJ. Quantifying tumour heterogeneity in 18F-FDG PET/CT imaging by texture analysis. Eur J Nucl Med Mol Imaging. 2013;40:133–40.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Professor Gary Cook and Dr Muhammad Siddique for helpful advice.

Author information

Authors and Affiliations

  1. Clinical Imaging Sciences Centre, Brighton Sussex Medical School, Brighton, UK

    Georgia Keramida, James Hunter & Sabina Dizdarevic

  2. Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton Sussex University Hopsitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK

    Georgia Keramida, Sabina Dizdarevic & A. Michael Peters

Authors
  1. Georgia Keramida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James Hunter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sabina Dizdarevic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Michael Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Michael Peters.

Ethics declarations

Conflict of interest

None to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keramida, G., Hunter, J., Dizdarevic, S. et al. Heterogeneity of intrahepatic fat distribution determined by 18F-FDG PET and CT. Ann Nucl Med 30, 200–206 (2016). https://doi.org/10.1007/s12149-015-1045-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-015-1045-8

Keywords

Search

Navigation