A review of F-18 fluorodeoxyglucose PET/CT in the evaluation and treatment of hepatobiliary tumors

Hepatocellular carcinoma (HCC) and biliary tract cancers (BTC) pose significant diagnostic and therapeutic challenges. Magnetic resonance imaging (MRI) and multiphase computed tomography (CT) have been the preferred imaging modalities for diagnosis, staging, and surveillance of patients with these malignancies. The best clinical outcomes depend on the appropriate selection of treatment options from the tools available in neo-adjuvant therapy, surgical resection, locoregional therapy, liver transplantation, and adjuvant therapy. While not a part of the routine diagnostic work-up or follow-up, F-18 fluorodeoxyglucose positron emission tomography (FDG PET/CT) can inform therapeutic decision making and help avoid futile surgeries by detecting unsuspected distant metastases. Additionally, metabolic information obtained with FDG PET/CT has prognostic value, predicting treatment response and survival. In patients with HCC metabolic parameters obtained by FDG PET/CT have been shown to correlate with microvascular invasion and predict recurrence in orthotopic transplant recipients. This article will highlight studies that have evaluated the role of FDG PET/CT in diagnosis, staging and therapeutic response assessment in patients with hepatobiliary cancers.