Does the viral hepatitis B infection have an effect on the detection of HCC on FDG PET-CT?

Objectives It suggested that the HBx protein caused by the HBV increase the activity of the HIF-1 activity, which is known to affect tumor growing of hepatocellular carcinoma (HCC) by inducing the angiogenesis and glycolysis. The object of our study was to determine whether the HBV infection status could affect the detectability of the HCC on FDG PET-CT and if there were any effects on prognosis prediction by FDG PET.

Methods We enrolled newly diagnosed 41 HCC patients. Maximum SUV (SUVmax) and tumor to normal liver ratio (TNR) were calculated. Active HBV infection (HBV+) group and inactive or negative (HBV-) group were determined by viral marker and DNA quantification. SUVmax and TNR of the HBV+ group were compared with those of the HBV- group by Mann-Whitney test. Survival analysis was performed by KM survival plot and log rank test.

Results Of 41 HCC patients, 20 were HBV+ and 21 were HBV-, respectively. Detection rate, SUVmax, and TNR of HBV+ group were 75%, 4.45±2.20, 2.07±1.30, and those of HBV- group were 48%, 3.86±2.20, 1.70±1.05, respectively. HBV+ group showed a tendency of higher figures than HBV- group (p>0.05). Among the child class A patients, SUVmax of HBV+ group was significantly higher than that of HBV- group (4.1±2.35 vs 3.1±1.32, p<0.05). In survival analysis, there was no significant difference in disease related survival between detected (FDG avid) HCC and undetected (FDG non-avid) HCC patients in the HBV+ group, whereas survival of the FDG non-avid HCC patients was significantly higher than the FDG avid HCC in the HBV- group(p<0.05).

Conclusions We found a tendency of higher HCC detection rate on FDG PET-CT in the group with active HBV infection on FDG PET-CT with a higher FDG uptake. In child class A, especially, SUVmax of HCC in the active HBV infection group was significantly higher. In HBV- group, FDG non-avid HCC suggested the better prognosis with a statistical significance, where as there was no difference in prognosis between the FDG avidities in the HBV+ patients group