PET/CT with ¹⁸F Fluorocholine as an Imaging Biomarker for Chronic Liver Disease: A Preliminary Radiopathologic...

Purpose To determine the relationship between hepatic uptake at preoperative fluorine 18 (¹⁸F) fluorocholine combined positron emission tomography (PET) and computed tomography (CT) and the histopathologic features of chronic liver disease in patients with Child-Pugh class A or B disease who are undergoing hepatic resection for liver cancer. Materials and Methods Forty-eight patients with resectable liver tumors underwent preoperative ¹⁸F fluorocholine PET/CT. Mean liver standardized uptake value (SUV_mean) measurements were obtained from PET images, while histologic indexes of inflammation and fibrosis were applied to nontumor liver tissue from resection specimens. Effects of histopathologic features on liver SUV_mean were examined with analysis of variance. Results Liver SUV_mean ranged from 4.3 to 11.6, correlating significantly with Knodell histologic activity index (ρ = -0.81, P < .001) and several clinical indexes of liver disease severity. Liver SUV_mean also differed significantly across groups stratified by necroinflammatory severity and Metavir fibrosis stage (P < . 001). The area under the receiver operating characteristic curve for ¹⁸F fluorocholine PET/CT detecting Metavir fibrosis stage F1 or higher was 0.89 ± 0.05, with an odds-ratio of 3.03 (95% confidence interval: 1.59, 5.88) and sensitivity and specificity of 82% and 93%, respectively. Conclusion Correlations found in patients undergoing hepatic resection for liver cancer between liver ¹⁸F fluorocholine uptake and histopathologic indexes of liver fibrosis and inflammation support the use of ¹⁸F fluorocholine PET/CT as a potential imaging biomarker for chronic liver disease. ^© RSNA, 2018.