Role of pre-transplant 18F-FDG PET/CT in predicting hepatocellular carcinoma recurrence after liver transplantation

The last two decades have seen a paradigm shift in the selection of patients with hepatocellular carcinoma(HCC)for liver transplantation.Microvascular invasion and differentiation have been the most significant factors affecting post-transplant recurrence;however,because of inherent disadvantages of pre-transplant biopsy,histological criteria never gained popularity.Recently,the selection criteria evolved from morphological to biological criteria,such as biomarkers and response to loco-regional therapy.With the introduction of multimodality imaging,combination of computed tomography with nuclear medicine imaging,particularly,18F-fluorodeoxyglucose positron emission tomography fulfilled an unmet need and rapidly became a critical component of HCC management.This review article will focus on the use of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in the pre-transplant evaluation of HCC patients with special discussion on its ability to predict HCC recurrence after liver transplantation.