الفهرس 
Radiological Anatomy of the LiverOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma is the most common primary malignant tumor of the liver. Transarterial chemoembolization (TACE) is one of the well-established and widely performed treatments for hepatocellular carcinoma (HCC). Follow-up for detection of new or remaining viable tumor is important in treatment strategy.
This study aimed to compare between the role PET/CT and triphasic CT in evaluation of HCC post chemo-embolization, hence guiding the clinician to proper management strategy.
This study included 30 patients (26 males and 4 females) had history of local treatment of HCC by TACE (2 patients had history of combined therapy by chemoembolization and radiofrequency).
Persistent elevated AFP levels were found at 27 patients and the remaining 3 patients had normal levels of AFP and were preparing for liver transplantation.
Of the 27 patients with persistent elevated AFP levels, triphasic CT detected residual tumoral tissue in 20 patients. Among the negative 7 patients, PET/CT showed pathological FDG uptake in 3 patients and extra hepatic spread in spite of successful local treatment in 4 patients. PET /CT was positive in 26 patients and negative in one patient who showed characteristic enhancement pattern of local recurrence at triphasic CT.
The other 3 patients with normal AFP level showed no abnormality at triphasic CT but there was a single patient showed focal FDG uptake due to regional hyperemia by PET/CT.
This study demonstrated higher sensitivity of PET CT over triphasic CT in detection of residual tumor after TACE. Triphasic CT showed sensitivity and specificity of 74 % and 100 % respectively with positive predictive value of 100 %, negative predictive value of 30 % and accuracy of 76.7 %. However PET CT showed sensitivity and specificity of 96.3 % and 66.7 % respectively with positive predictive value of 96.3 %, negative predictive value of 66.7 % and accuracy of 93.3 %.
In conclusion: PET/CT showed higher accuracy over triphasic CT in assessment of the intervention bed without affection by lipiodol artifact as well as detection of extra hepatic spread of HCC in single whole body examination which is crucial for patients preparing for liver transplantation and differentiation between benign and malignant portal vein thrombosis. However, a larger number of patients and longer term study are still needed to validate the results of this study.