Role of FDG in the management of metastatic hepatic tumors treated with chemoembolization

Objectives: Examine the role of FDG-PET/CT imaging in hepatic tumors pre- and post-chemoembolization in patient selection, patient prognosis, and treatment response.

Methods: Chemoembolization is a well-established method for locoregional treatment of patients with hepatic tumors, for decreasing tumor burden, preventing metastatic spread, and as a treatment bridge to liver transplant in some patients. Therefore, careful selection of patients through proper staging as well as a tool for monitoring therapy response is critical. Results: The hybrid imaging technique of FDG-PET/CT provides functional as well as anatomical information in understanding tumors’ behavior, thereby providing molecular information about a tumor before its manifestation anatomically. Quantitative PET analysis is a technique that can aid in the selection, evaluation, and continued management of patients undergoing chemoembolization for liver metastases. We demonstrate a quantitative method which incorporates all the malignant lesions using the adaptive thresholding algorithm of ROVER software (ABX GmbH, Radeberg, Germany) which is a representation of the global disease burden. Through the measurement of global SUV, quantitatively, we can determine the extent of response to treatment more efficiently through PET imaging pre- and post-chemoembolization as well as DTP (Dual time-point) imaging. Conclusion: The application of quantitative FDG-PET/CT throughout global disease assessment and the implementation of DTP imaging in the management of hepatic tumors treated by chemoembolization can be an effective method for selecting subjects, determining prognosis and assessing response to treatment.