Value of 18F-FDG PET/CT in the diagnosis of portal vein tumor thrombus in patients with hepatocellular carcinoma

  • Bing Wu
  • Yiqiu Zhang
  • Hui Tan
  • Hongcheng ShiEmail author



The aim of this study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for the diagnosis of a portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma (HCC).


One hundred fifty-four patients with histologically proven HCC underwent 18F-FDG PET/CT imaging. The maximum standardized uptake value (SUVmax) was calculated, and the change in SUVmax (retention index, RI) was defined as the ratio of the increase in SUVmax between early and delayed scans to the SUVmax in the early scan. The circular region of interest was placed on the transaxial images according to the corresponding CT images. The final diagnoses of a PVTT were confirmed by histopathology.


Of the patients examined, 101 (65.6%) had no confirmed instances of a PVTT, whereas 53 (34.4%) had a confirmed PVTT. The sensitivity of 18F-FDG PET/CT imaging was 62.3%, the specificity was 97.0%, the accuracy was 85.1%, the positive predictive value was 91.7%, and the negative predictive value was 83.1%. The SUVmax of the PVTT was 4.32 ± 1.96 and the SUVmax of the HCC lesions for these patients was 5.38 ± 2.79, but these differences were insignificant (t = 1.78, p = 0.08). For dual-time-point imaging, the SUV1 of the PVTT lesions was 3.75 ± 1.48, and SUV2 was 3.63 ± 1.41, but these differences were insignificant (t = 0.82, p = 0.42). The SUV1 of the HCC lesions was 4.47 ± 2.03, and the SUV2 was 4.90 ± 2.07, which were both also insignificant (t = − 1.81, p = 0.09). The RI of the PVTT lesions was − 2.05 ± 19.96%, and the RI of the HCC lesions was 11.87 ± 26.20%, with no significant differences between them (t = 1.58, p = 0.13).


18F-FDG PET/CT may potentially improve the accurate diagnoses of a PVTT in patients with HCC.


18F-FDG PET/CT Hepatocellular carcinoma Portal vein tumor thrombus 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Parkin, D.M., et al., Estimating the world cancer burden: Globocan 2000. Int J Cancer, 2001. 94(2): p. 153-6.CrossRefGoogle Scholar
  2. 2.
    Ahn, S.J., et al., (1)(8)F-FDG PET metabolic parameters and MRI perfusion and diffusion parameters in hepatocellular carcinoma: a preliminary study. PLoS One, 2013. 8(8): p. e71571.CrossRefGoogle Scholar
  3. 3.
    Lau, W.Y., et al., Treatment for hepatocellular carcinoma with portal vein tumor thrombosis: the emerging role for radioembolization using yttrium-90. Oncology, 2013. 84(5): p. 311-8.CrossRefGoogle Scholar
  4. 4.
    Kim, J.M., et al., The effect of alkaline phosphatase and intrahepatic metastases in large hepatocellular carcinoma. World J Surg Oncol, 2013. 11: p. 40.CrossRefGoogle Scholar
  5. 5.
    Rogoveanu, I., et al., Diagnostic particularities in primitive diffuse form hepatocellular carcinoma associated with portal vein thrombosis. Rom J Morphol Embryol, 2005. 46(4): p. 317-21.Google Scholar
  6. 6.
    Llovet, J.M., et al., Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology, 1999. 29(1): p. 62-7.CrossRefGoogle Scholar
  7. 7.
    Takizawa, D., et al., Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis. Dig Dis Sci, 2007. 52(11): p. 3290-5.CrossRefGoogle Scholar
  8. 8.
    Kurtovic, J., H. Van Der Wall and S.M. Riordan, FDG PET for discrimination between tumor extension and blood thrombus as a cause for portal vein thrombosis in hepatocellular carcinoma: important role in exclusion of transplant candidacy. Clin Nucl Med, 2005. 30(6): p. 408-10.CrossRefGoogle Scholar
  9. 9.
    Aras, M., et al., FDG PET/CT appearance of portal vein tumor thrombus in the gastric primitive neuroectodermal tumor: uncommon primary tumor site with rare finding. Clin Nucl Med, 2013. 38(1): p. 47-9.CrossRefGoogle Scholar
  10. 10.
    Sun, L., et al., Positron emission tomography/computed tomography with (18)F-fluorodeoxyglucose identifies tumor growth or thrombosis in the portal vein with hepatocellular carcinoma. World J Gastroenterol, 2007. 13(33): p. 4529-32.CrossRefGoogle Scholar
  11. 11.
    Tarantino, L., et al., Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy. Abdom Imaging, 2006. 31(5): p. 537-44.CrossRefGoogle Scholar
  12. 12.
    Tublin, M.E., G.R. Dodd and Baron RL, Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol, 1997. 168(3): p. 719-23.Google Scholar
  13. 13.
    Erhamamci, S., et al., Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol, 2015. 34(5): p. 287-94.Google Scholar
  14. 14.
    Bagni, O., et al., (18)F-FDG PET/CT imaging of massive portal vein tumor thrombosis from ileal adenocarcinoma. Hell J Nucl Med, 2014. 17(1): p. 52-3.Google Scholar
  15. 15.
    Hu, S., et al., The role of 18F-FDG PET/CT in differentiating malignant from benign portal vein thrombosis. Abdom Imaging, 2014. 39(6): p. 1221-7.CrossRefGoogle Scholar
  16. 16.
    Hanajiri, K., et al., 18F-FDG PET for hepatocellular carcinoma presenting with portal vein tumor thrombus. J Gastroenterol, 2005. 40(10): p. 1005-6.CrossRefGoogle Scholar
  17. 17.
    Beadsmoore, C.J., et al., Hepatocellular carcinoma tumour thrombus in a re-canalised para-umbilical vein: detection by 18-fluoro-2-deoxyglucose positron emission tomography imaging. Br J Radiol, 2005. 78(933): p. 841-4.CrossRefGoogle Scholar
  18. 18.
    Sun, L., et al., Highly metabolic thrombus of the portal vein: 18F fluorodeoxyglucose positron emission tomography/computer tomography demonstration and clinical significance in hepatocellular carcinoma. World J Gastroenterol, 2008. 14(8): p. 1212-7.CrossRefGoogle Scholar
  19. 19.
    Sacks, A., et al., Value of PET/CT in the management of primary hepatobiliary tumors, part 2. AJR Am J Roentgenol, 2011. 197(2): p. W260-5.CrossRefGoogle Scholar
  20. 20.
    Shum, W.Y., et al., Clinical usefulness of dual-time FDG PET-CT in assessment of esophageal squamous cell carcinoma. Eur J Radiol, 2012. 81(5): p. 1024-8.CrossRefGoogle Scholar
  21. 21.
    Fuster, D., et al., [Dual-time point images of the liver with (18)F-FDG PET/CT in suspected recurrence from colorectal cancer]. Rev Esp Med Nucl Imagen Mol, 2012. 31(3): p. 111-6.Google Scholar
  22. 22.
    Lin, C.Y., et al., 18F-FDG PET or PET/CT for detecting extrahepatic metastases or recurrent hepatocellular carcinoma: a systematic review and meta-analysis. Eur J Radiol, 2012. 81(9): p. 2417-22.CrossRefGoogle Scholar
  23. 23.
    Dirisamer, A., et al., Dual-time-point FDG-PET/CT for the detection of hepatic metastases. Mol Imaging Biol, 2008. 10(6): p. 335-40.CrossRefGoogle Scholar
  24. 24.
    Tsuda, M., et al., Time-related changes of radiofrequency ablation lesion in the normal rabbit liver: findings of magnetic resonance imaging and histopathology. Invest Radiol, 2003. 38(8): p. 525-31.Google Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nuclear Medicine, Zhongshan HospitalFudan UniversityShanghaiChina
  2. 2.Nuclear Medicine Institute of Fudan UniversityShanghaiChina
  3. 3.Shanghai Institute of Medical ImagingShanghaiChina

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