Şadiye ALTUNTUZCU, Fatih GUZEL, Ali UYAR, İhsan KAPLAN, Yunus GÜZEL, Bekir TAŞDEMİR, Kendal YALÇIN

Is there a relationship between the liver SUVmax values in FDG-PET/CT imaging and non-alcoholic fatty liver disease score?

Aim: Non-alcoholic fatty liver disease is one of the most common causes of liver disease worldwide with an estimated prevalence of 20%–30% in adult population. Following the widespread utilization of PET in the evaluation of malignant diseases, F-18 FDG have also been reported to be used in non-malignant processes. The aim of this study is to elucidate whether the FDG SUVmax values determined by PET/CT in different adipose tissue samples and the liver change according to NAFLD score. During our desktop research we did not find any published article therefore, it is the first study in this field. Materials and Method: A total of 230 patients who applied to Dicle University Faculty of Medicine, Department of Nuclear Medicine between March and April 2020 and who have been conducted FDG PET/CT for diagnosis, staging, restaging and evaluation of response to treatment were included in the study. Patients were divided into three groups according to their NAFLD score as patients with fibrosis score 0.676 (severe fibrosis group) group-3. Results: Liver SUVmax levels were found to be significantly higher in group-3 than group-1. No significant difference was observed between group-2 and group-3. SUVmax levels measured from supracalvicular region, posterior scapular region and mesentery region were not different from each other in all three groups. Glucose-corrected liver SUVglu levels were found to be significantly lower in group-1 than group-3 (p=0.001). In terms of liver SUVglu levels, group-1 and group-2 and group-2 and group-3 did not differ statistically from each other. Supracalvicular SUVglu, posterior scapular SUVglu and mesenteric SUVglu groups were not different from each other. Conclusions: The most important result of this study could be elaborated with increased FDG uptake in NAFLD. Liver FDG uptake increases as the severity of NAFLD increases as demonstrated by the NAFLD score.

Keywords:

SUVmax, FDG-PET/CT, nonalcoholic steatohepatitis score,

PDF

___

Schaffner F, Thaler H. Nonalcoholic fatty liver disease. Prog Liver Dis 1986: 8: 283-98.
Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Ann Intern Med 1997; 126: 137-45.
Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413-9.
Reid AE. Nonalcoholic steatohepatitis. Gastroenterology 2001; 121: 710-23.
Wah-Kheong C, Khean-Lee G. Epidemiology of a fast emerging disease in the Asia-Pacific region: non-alcoholic fatty liver disease. Hepatol Int 2013;7(1):65–71.
Papamiltiadous ES, Roberts SK, Nicoll AJ, et al. A randomised controlled trial of a Mediterranean Dietary Intervention for Adults with Non Alcoholic Fatty Liver Disease (MEDINA): study protocol. BMC Gastroenterol 2016; 16: 14.
Parisi MT. Functional imaging of infection: conventional nuclear medicine agents and the expanding role of 18-F-FDG PET. Pediatr Radiol. 2011;41:803–10.
Israel O, Keidar Z. PET/CT imaging in infectious conditions. Ann N Y Acad Sci 2011; 1228: 150–66.
European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO) EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64: 1388–402.
Lin CY, Ding HJ, Lin CC, et al. Impact of age on FDG uptake in the liver on PET scan Clin Imaging 2010; 34: 348-50.
Keramida G, Potts J, Bush J, Dizdarevic S, Peters AM. Hepatic steatosis is associated with increased hepatic FDG uptake.Eur J Radiol 2014; 83: 751-5.
Khandani AH, Wahl RL. Applications of PET in liver imaging .Radiol Clin North Am 2005; 43: 849–60.
Kumar R, Xiu Y, Yu JQ, et al. 18 F-FDG PET in evaluation of adrenal lesions inpatients with lung cancer. J Nucl Med 2004; 45: 2058–62.
van KouwenMC, Jansen JB, van Goor H, et al. FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis . Eur J Nucl Med Mol Imaging 2005; 32: 399–404 .
Barrington NG, Mikhaeel L, Kostakoglu, et al. Role of imaging in thestaging and response assessment of lymphoma: consensus of theinternational conference on malignant lymphomas imaging working group. J Clin Oncol 2014; 32: 3048–58.
Angulo P, Hui JM, Marchesini G, et al. TheNAFLD ﬁbrosis score: a noninvasive system that identiﬁes liver ﬁbrosis inpatients with NAFLD. Hepatology 2007; 45: 846–854.
Lee SM, Kim TS, Lee JW, Kim SK, Park SJ, Han SS. Improved prognostic value of standardized uptake value corrected for blood glucose level in pancreatic cancer using F-18 FDG PET. Clin Nucl Med 2011; 36: 331-6.
Wang G, Corwin M, Olson K, et al. Dynamic FDG-PET study of liver inflammation in non-alcoholic fatty liver disease. J Hepatol 2017; 66: 543–750.
Imajo K, Honda Y, Yoneda M, Saito S, Nakajima A. Magnetic resonance imaging for the assessment of pathological hepatic findings in nonalcoholic fatty liver disease. J Med Ultrason (2001). 2020; 47: 535-48.
Hain SF, Curran KM, Beggs AD, et al. FDG-PET as a “metabolic biopsy” tool in thoracic lesions with indeterminate biopsy. Eur J Nucl Med 2001; 28: 1336–40.
Beggs AD, Hain SF, Curran KM, O’Doherty MJ. FDG-PET as a “metabolic biopsy” tool in non-lung lesions with indeterminate biopsy. Eur J Nucl Med Mol Imaging 2002; 29: 542–6.
Keramida G, Potts J, Bush J, et al. Accumulation of (18)F-FDG in the liver in hepatic steatosis.AJR Am J Roentgenol. 2014; 203: 643-8. Erratum in: AJR Am J Roentgenol 2015; 204: 1137.
Kim YH, Kim JY, Jang SJ, et al. F-18 FDG uptake in focal fatty infiltration of liver mimicking hepatic malignancy on PET/CT images. Clin Nucl Med 2011; 36: 1146-8.
Le Y, Chen Y, Huang Z,Cai L, Zhang L.Intense FDG activity in focal hepatic steatosis.Clin Nucl Med 2014; 39: 669-72.
Han N, Feng H, Arnous MM, Bouhari A, Lan X.Multiple liver focal fat sparing lesions with unexpectedly increased (18)F-FDG uptake mimicking metastases examined by ultrasound (18)F-FDG PET/CT and MRI. Hell J Nucl Med 2016; 19: 173-5.
Qazi F, Oliver D, Nguyen N, Osman M. Fatty liver: impact on metabolic activity as detected with18F FDG-PET/CT. J Nucl Med 2008; 49: 263.
Ozulker T, Ozulker F, Assessment of the Effect of Fatty Infiltration on Hepatic FDG Uptake, Eur Arch Med Res 2019; 35: 27-32
Pak K, Kim SJ, Kim IJ, Kim K, Kim H, Kim SJ. Hepatic FDG Uptake is not Associated with Hepatic Steatosis but with Visceral Fat Volume in Cancer Screening. Nucl Med Mol Imaging 2012; 46: 176-81.
Bural GG, Torigian DA, Burke A, et al. Quantitative assessment of the hepatic metabolic volume product in patients with diffuse hepatic steatosis and normal controls through use of FDG-PET and MR imaging: a novel concept. Mol Imaging Biol 2010; 12: 233-9.