FDG PET for Discrimination Between Tumor Extension and Blood Thrombus as a Cause for Portal Vein Thrombosis in Hepatocellular Carcinoma: Important Role in Exclusion of Transplant Candidacy

Abstract

In patients with cirrhosis and complicating hepatocellular carcinoma (HCC), liver transplantation (LT) offers the only hope for cure of both the HCC and cirrhosis. Recent data indicate that patients with HCC with larger intrahepatic tumor burdens than previously thought can expect excellent long-term survival with LT. However, tumor extension into the portal vein remains an absolute contraindication to LT because of early tumor recurrence. Although portal vein thrombosis (PVT) is readily detected by dynamic computed tomography or Doppler ultrasound, these do not discriminate between tumor extension and blood thrombus, which occurs commonly in cirrhosis, as the cause. We report a 46-year-old man with hepatitis B virus-related cirrhosis complicated by HCC and PVT. Positron emission tomography using F-18 FDG showed the cause of PVT to be tumor extension rather than blood thrombus, thereby contraindicating LT. In patients with HCC with PVT, abnormal F-18 FDG uptake in the portal vein indicates tumor thrombus and plays an important role in excluding LT candidacy.