Skip to main content
SpringerLink
Log in

The prognostic value of 18F–FDG PET/CT prior to liver transplantation for nonresectable colorectal liver metastases

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The main objective of this study was to evaluate the prognostic value of volumetric and metabolic information derivied from F-18 fluorodeoxyglucose positron emission tomography (18F–FDG PET) in combination with computed tomography (CT) prior to liver transplantation (LT) in patients with nonresectable colorectal liver metastases (CLM). Due to scarcity of liver grafts, prognostic information enabling selection of candidates who will gain the highest survival after LT is of vital importance. 18F–FDG PET/CT was a part of the preoperative study protocol. Patients without evidence of extrahepatic malignant disease on 18F–FDG PET/CT who also fulfilled all the other inclusion criteria underwent LT.

Methods

The preoperative 18F–FDG PET/CT examinations of all patients included in the SECA (secondary cancer) study were retrospectively assessed. Maximum, mean and peak standardized uptake values (SUVmax, SUVmean and SUVpeak), tumor to background (T/B) ratio, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured and calculated for all liver metastases. Total MTV and TLG were calculated for each patient. Cut-off values were determined for each of these parameters by using receiver operating characteristic (ROC) analysis dividing the patients into two groups. One, three and five-year overall survival (OS) and disease free survival (DFS) for patients over and under the cut-off value were compared by using the Kaplan–Meier method and log rank test.

Results

Twenty-three patients underwent LT in the SECA study. Total MTV and TLG under the cut-off values were significantly correlated to improved OS at three and five years (p = 0.027 and 0.026) and DFS (p = 0.01). One, three and five-year OS and DFS were not significantly related to SUVmax, SUVmean, SUVpeak or T/B-ratio.

Conclusion

Total MTV and TLG from 18F FDG PET/CT prior to LT for nonresectable CLM were significantly correlated to improved three and five-year OS and DFS and can potentially improve the patient selection for LT.

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

Similar content being viewed by others

References

  1. Kanas GP, Taylor A, Primrose JN, Langeberg WJ, Kelsh MA, Mowat FS, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol. 2012;4:283–301. https://doi.org/10.2147/CLEP.S34285.

    PubMed  PubMed Central  Google Scholar 

  2. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9. https://doi.org/10.1056/NEJM199603143341104.

    Article  CAS  PubMed  Google Scholar 

  3. Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10:35–43. https://doi.org/10.1016/S1470-2045(08)70284-5.

    Article  PubMed  Google Scholar 

  4. Masuoka HC, Rosen CB. Transplantation for cholangiocarcinoma. Clin Liver Dis. 2011;15:699–715. https://doi.org/10.1016/j.cld.2011.08.004.

    Article  PubMed  Google Scholar 

  5. Lee KK, Kim DG, Moon IS, Lee MD, Park JH. Liver transplantation versus liver resection for the treatment of hepatocellular carcinoma. J Surg Oncol. 2010;101:47–53. https://doi.org/10.1002/jso.21415.

    Article  PubMed  Google Scholar 

  6. Le Treut YP, Gregoire E, Klempnauer J, Belghiti J, Jouve E, Lerut J, et al. Liver transplantation for neuroendocrine tumors in Europe-results and trends in patient selection: a 213-case European liver transplant registry study. Ann Surg. 2013;257:807–15. https://doi.org/10.1097/SLA.0b013e31828ee17c.

    Article  PubMed  Google Scholar 

  7. Hoti E, Adam R. Liver transplantation for primary and metastatic liver cancers. Transpl Int. 2008;21:1107–17. https://doi.org/10.1111/j.1432-2277.2008.00735.x.

    Article  PubMed  Google Scholar 

  8. Hagness M, Foss A, Line PD, Scholz T, Jorgensen PF, Fosby B, et al. Liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg. 2013;257:800–6. https://doi.org/10.1097/SLA.0b013e3182823957.

    Article  PubMed  Google Scholar 

  9. Briggs RH, Chowdhury FU, Lodge JP, Scarsbrook AF. Clinical impact of FDG PET-CT in patients with potentially operable metastatic colorectal cancer. Clin Radiol. 2011;66:1167–74. https://doi.org/10.1016/j.crad.2011.07.046.

    Article  CAS  PubMed  Google Scholar 

  10. Lin M, Wong K, Ng WL, Shon IH, Morgan M. Positron emission tomography and colorectal cancer. Crit Rev Oncol Hematol. 2011;77:30–47. https://doi.org/10.1016/j.critrevonc.2010.04.011.

    Article  PubMed  Google Scholar 

  11. Network NCC. National Comprehensive Cancer Network (NCCN) Guidelines Version 32017 Colon and Rectal Cancer 2017.

    Google Scholar 

  12. Bipat S, van Leeuwen MS, Comans EF, Pijl ME, Bossuyt PM, Zwinderman AH, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis--meta-analysis. Radiology. 2005;237:123–31. https://doi.org/10.1148/radiol.2371042060.

    Article  PubMed  Google Scholar 

  13. Maffione AM, Lopci E, Bluemel C, Giammarile F, Herrmann K, Rubello D. Diagnostic accuracy and impact on management of (18)F-FDG PET and PET/CT in colorectal liver metastasis: a meta-analysis and systematic review. Eur J Nucl Med Mol Imaging. 2015;42:152–63. https://doi.org/10.1007/s00259-014-2930-4.

    Article  CAS  PubMed  Google Scholar 

  14. Patel S, McCall M, Ohinmaa A, Bigam D, Dryden DM. Positron emission tomography/computed tomographic scans compared to computed tomographic scans for detecting colorectal liver metastases: a systematic review. Ann Surg. 2011;253:666–71. https://doi.org/10.1097/SLA.0b013e31821110c9.

    Article  PubMed  Google Scholar 

  15. Ozis SE, Soydal C, Akyol C, Can N, Kucuk ON, Yagci C, et al. The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the primary staging of rectal cancer. World J Surg Oncol. 2014;12:26. https://doi.org/10.1186/1477-7819-12-26.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med. 2004;45:1431–4.

    PubMed  Google Scholar 

  17. Tam HH, Cook GJ, Chau I, Drake B, Zerizer I, Du Y, et al. The role of routine clinical pretreatment 18F-FDG PET/CT in predicting outcome of colorectal liver metastasis. Clin Nucl Med. 2015;40:e259–64. https://doi.org/10.1097/rlu.0000000000000744.

    Article  PubMed  Google Scholar 

  18. Xia Q, Liu J, Wu C, Song S, Tong L, Huang G, et al. Prognostic significance of (18)FDG PET/CT in colorectal cancer patients with liver metastases: a meta-analysis. Cancer Imaging. 2015;15:19. https://doi.org/10.1186/s40644-015-0055-z.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bai B, Bading J, Conti PS. Tumor quantification in clinical positron emission tomography. Theranostics. 2013;3:787–801. https://doi.org/10.7150/thno.5629.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hyun SH, Choi JY, Shim YM, Kim K, Lee SJ, Cho YS, et al. Prognostic value of metabolic tumor volume measured by 18F-fluorodeoxyglucose positron emission tomography in patients with esophageal carcinoma. Ann Surg Oncol. 2010;17:115–22. https://doi.org/10.1245/s10434-009-0719-7.

    Article  PubMed  Google Scholar 

  21. Pan L, Gu P, Huang G, Xue H, Wu S. Prognostic significance of SUV on PET/CT in patients with esophageal cancer: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2009;21:1008–15. https://doi.org/10.1097/MEG.0b013e328323d6fa.

    Article  PubMed  Google Scholar 

  22. Al-Sarraf N, Gately K, Lucey J, Aziz R, Doddakula K, Wilson L, et al. Clinical implication and prognostic significance of standardised uptake value of primary non-small cell lung cancer on positron emission tomography: analysis of 176 cases. Eur J Cardiothorac Surg. 2008;34:892–7. https://doi.org/10.1016/j.ejcts.2008.07.023.

    Article  PubMed  Google Scholar 

  23. Downey RJ, Akhurst T, Gonen M, Vincent A, Bains MS, Larson S, et al. Preoperative F-18 fluorodeoxyglucose-positron emission tomography maximal standardized uptake value predicts survival after lung cancer resection. J Clin Oncol. 2004;22:3255–60. https://doi.org/10.1200/JCO.2004.11.109.

    Article  PubMed  Google Scholar 

  24. Zhang H, Wroblewski K, Appelbaum D, Pu Y. Independent prognostic value of whole-body metabolic tumor burden from FDG-PET in non-small cell lung cancer. Int J Comput Assist Radiol Surg. 2013;8:181–91. https://doi.org/10.1007/s11548-012-0749-7.

    Article  PubMed  Google Scholar 

  25. Dibble EH, Alvarez AC, Truong MT, Mercier G, Cook EF, Subramaniam RM. 18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer: adding value to clinical staging. J Nucl Med. 2012;53:709–15. https://doi.org/10.2967/jnumed.111.099531.

    Article  CAS  PubMed  Google Scholar 

  26. Higgins KA, Hoang JK, Roach MC, Chino J, Yoo DS, Turkington TG, et al. Analysis of pretreatment FDG-PET SUV parameters in head-and-neck cancer: tumor SUVmean has superior prognostic value. Int J Radiat Oncol Biol Phys. 2012;82:548–53. https://doi.org/10.1016/j.ijrobp.2010.11.050.

    Article  PubMed  Google Scholar 

  27. Shady W, Kishore S, Gavane S, Do RK, Osborne JR, Ulaner GA, et al. Metabolic tumor volume and total lesion glycolysis on FDG-PET/CT can predict overall survival after (90)Y radioembolization of colorectal liver metastases: A comparison with SUVmax, SUVpeak, and RECIST 1.0. Eur J Radiol. 2016;85:1224–31. https://doi.org/10.1016/j.ejrad.2016.03.029.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ogawa S, Itabashi M, Kondo C, Momose M, Sakai S, Kameoka S. Prognostic Value of Total Lesion Glycolysis Measured by 18F-FDG-PET/CT in Patients with Colorectal Cancer. Anticancer Res. 2015;35:3495–500.

    CAS  PubMed  Google Scholar 

  29. Kim YI, Paeng JC, Cheon GJ, Suh KS, Lee DS, Chung JK, et al. Prediction of Posttransplantation Recurrence of Hepatocellular Carcinoma Using Metabolic and Volumetric Indices of 18F-FDG PET/CT. J Nucl Med. 2016;57:1045–51. https://doi.org/10.2967/jnumed.115.170076.

    Article  CAS  PubMed  Google Scholar 

  30. Gulec SA, Suthar RR, Barot TC, Pennington K. The prognostic value of functional tumor volume and total lesion glycolysis in patients with colorectal cancer liver metastases undergoing 90Y selective internal radiation therapy plus chemotherapy. Eur J Nucl Med Mol Imaging. 2011;38:1289–95. https://doi.org/10.1007/s00259-011-1758-4.

    Article  CAS  PubMed  Google Scholar 

  31. Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50(Suppl 1):122S–50S. https://doi.org/10.2967/jnumed.108.057307.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Bailly M, Venel Y, Orain I, Salame E, Ribeiro MJ. 18F-FDG PET in Liver Transplantation Setting of Hepatocellular Carcinoma: Predicting Histology? Clin Nucl Med. 2016;41:e126–9. https://doi.org/10.1097/rlu.0000000000001040.

    Article  PubMed  Google Scholar 

  33. Detry O, Govaerts L, Deroover A, Vandermeulen M, Meurisse N, Malenga S, et al. Prognostic value of (18)F-FDG PET/CT in liver transplantation for hepatocarcinoma. World J Gastroenterol. 2015;21:3049–54. https://doi.org/10.3748/wjg.v21.i10.3049.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Lee SD, Kim SH, Kim YK, Kim C, Kim SK, Han SS, et al. (18)F-FDG-PET/CT predicts early tumor recurrence in living donor liver transplantation for hepatocellular carcinoma. Transpl Int. 2013;26:50–60. https://doi.org/10.1111/j.1432-2277.2012.01572.x.

    Article  PubMed  Google Scholar 

  35. Lin CY, Liao CW, Chu LY, Yen KY, Jeng LB, Hsu CN, et al. Predictive Value of 18F-FDG PET/CT for Vascular Invasion in Patients With Hepatocellular Carcinoma Before Liver Transplantation. Clin Nucl Med. 2017;42:e183–e7. https://doi.org/10.1097/RLU.0000000000001545.

    Article  PubMed  Google Scholar 

  36. Fendler WP, Philippe Tiega DB, Ilhan H, Paprottka PM, Heinemann V, Jakobs TF, et al. Validation of several SUV-based parameters derived from 18F-FDG PET for prediction of survival after SIRT of hepatic metastases from colorectal cancer. J Nucl Med. 2013;54:1202–8. https://doi.org/10.2967/jnumed.112.116426.

    Article  CAS  PubMed  Google Scholar 

  37. Soydal C, Kucuk ON, Gecim EI, Bilgic S, Elhan AH. The prognostic value of quantitative parameters of 18F-FDG PET/CT in the evaluation of response to internal radiation therapy with yttrium-90 in patients with liver metastases of colorectal cancer. Nucl Med Commun 2013;34:501-506. doi:https://doi.org/10.1097/MNM.0b013e32835f9427.

  38. Zerizer I, Al-Nahhas A, Towey D, Tait P, Ariff B, Wasan H, et al. The role of early (1)(8)F-FDG PET/CT in prediction of progression-free survival after (9)(0)Y radioembolization: comparison with RECIST and tumour density criteria. Eur J Nucl Med Mol Imaging. 2012;39:1391–9. https://doi.org/10.1007/s00259-012-2149-1.

    Article  CAS  PubMed  Google Scholar 

  39. Sabet A, Meyer C, Aouf A, Sabet A, Ghamari S, Pieper CC, et al. Early post-treatment FDG PET predicts survival after 90Y microsphere radioembolization in liver-dominant metastatic colorectal cancer. Eur J Nucl Med Mol Imaging. 2015;42:370–6. https://doi.org/10.1007/s00259-014-2935-z.

    Article  CAS  PubMed  Google Scholar 

  40. Hagness M, Foss A, Egge TS, Dueland S. Patterns of recurrence after liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg Oncol. 2014;21:1323–9. https://doi.org/10.1245/s10434-013-3449-9.

    Article  PubMed  Google Scholar 

  41. Kapoor V, McCook BM, Torok FS. An introduction to PET-CT imaging. Radiographics. 2004;24:523–43. https://doi.org/10.1148/rg.242025724.

    Article  PubMed  Google Scholar 

  42. Pettinato C, Nanni C, Farsad M, Castellucci P, Sarnelli A, Civollani S, et al. Artefacts of PET/CT images. Biomedical Imaging and Intervention Journal. 2006;2:e60. https://doi.org/10.2349/biij.2.4.e60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Chi A, Nguyen NP. 4D PET/CT as a Strategy to Reduce Respiratory Motion Artifacts in FDG-PET/CT. Front Oncol. 2014;4:205. https://doi.org/10.3389/fonc.2014.00205.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.o.box 4950, Nydalen, 0424, Oslo, Norway

    Harald Grut & Mona Elisabeth Revheim

  2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Harald Grut, Pål Dag Line & Mona Elisabeth Revheim

  3. Division of Oncology, Oslo University Hospital, Oslo, Norway

    Svein Dueland

  4. Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway

    Pål Dag Line

Authors
  1. Harald Grut
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Svein Dueland
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pål Dag Line
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mona Elisabeth Revheim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Harald Grut.

Ethics declarations

The authors declare no conflict of interest.

Informed consent was obtained from all individual participants included in the study.

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.

The SECA study was an open prospective study with institutional and regional ethical board approval (S-05409 Regional Ethics Committee. SECA study, ClinicalTrials.gov: NCT01311453).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grut, H., Dueland, S., Line, P.D. et al. The prognostic value of 18F–FDG PET/CT prior to liver transplantation for nonresectable colorectal liver metastases. Eur J Nucl Med Mol Imaging 45, 218–225 (2018). https://doi.org/10.1007/s00259-017-3843-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-017-3843-9

Keywords

Search

Navigation