PET/CT with 18F Fluorocholine as an Imaging Biomarker for Chronic Liver Disease: A Preliminary Radiopathologic Correspondence Study in Patients with Liver Cancer

Abstract

Purpose To determine the relationship between hepatic uptake at preoperative fluorine 18 (18F) fluorocholine combined positron emission tomography (PET) and computed tomography (CT) and the histopathologic features of chronic liver disease in patients with Child-Pugh class A or B disease who are undergoing hepatic resection for liver cancer. Materials and Methods Forty-eight patients with resectable liver tumors underwent preoperative 18F fluorocholine PET/CT. Mean liver standardized uptake value (SUVmean) measurements were obtained from PET images, while histologic indexes of inflammation and fibrosis were applied to nontumor liver tissue from resection specimens. Effects of histopathologic features on liver SUVmean were examined with analysis of variance. Results Liver SUVmean ranged from 4.3 to 11.6, correlating significantly with Knodell histologic activity index (ρ = -0.81, P < .001) and several clinical indexes of liver disease severity. Liver SUVmean also differed significantly across groups stratified by necroinflammatory severity and Metavir fibrosis stage (P < . 001). The area under the receiver operating characteristic curve for 18F fluorocholine PET/CT detecting Metavir fibrosis stage F1 or higher was 0.89 ± 0.05, with an odds-ratio of 3.03 (95% confidence interval: 1.59, 5.88) and sensitivity and specificity of 82% and 93%, respectively. Conclusion Correlations found in patients undergoing hepatic resection for liver cancer between liver 18F fluorocholine uptake and histopathologic indexes of liver fibrosis and inflammation support the use of 18F fluorocholine PET/CT as a potential imaging biomarker for chronic liver disease. © RSNA, 2018.

Figures

Figure 1a:

Differences in liver mean standardized uptake value (SUVmean) across Knodell indexes of histologic activity. Error bars indicate standard error above and below the mean. Post hoc Tukey-Kramer analysis revealed significant pairwise differences for (a) portal inflammation score (0 vs 3, 0 vs 4, 1 vs 3, 1 vs 4), (b) piecemeal necrosis score (0 vs 1, 0 vs 3), and (c) fibrosis score (0 vs 3, 0 vs 4, 1 vs 4, 0 vs 1). Corresponding P values adjusted for multiple comparisons are shown. (d) There were no significant differences between lobular inflammation scores.

Figure 1b:

Differences in liver mean standardized uptake value (SUVmean) across Knodell indexes of histologic activity. Error bars indicate standard error above and below the mean. Post hoc Tukey-Kramer analysis revealed significant pairwise differences for (a) portal inflammation score (0 vs 3, 0 vs 4, 1 vs 3, 1 vs 4), (b) piecemeal necrosis score (0 vs 1, 0 vs 3), and (c) fibrosis score (0 vs 3, 0 vs 4, 1 vs 4, 0 vs 1). Corresponding P values adjusted for multiple comparisons are shown. (d) There were no significant differences between lobular inflammation scores.

Figure 1c:

Differences in liver mean standardized uptake value (SUVmean) across Knodell indexes of histologic activity. Error bars indicate standard error above and below the mean. Post hoc Tukey-Kramer analysis revealed significant pairwise differences for (a) portal inflammation score (0 vs 3, 0 vs 4, 1 vs 3, 1 vs 4), (b) piecemeal necrosis score (0 vs 1, 0 vs 3), and (c) fibrosis score (0 vs 3, 0 vs 4, 1 vs 4, 0 vs 1). Corresponding P values adjusted for multiple comparisons are shown. (d) There were no significant differences between lobular inflammation scores.

Figure 1d:

Differences in liver mean standardized uptake value (SUVmean) across Knodell indexes of histologic activity. Error bars indicate standard error above and below the mean. Post hoc Tukey-Kramer analysis revealed significant pairwise differences for (a) portal inflammation score (0 vs 3, 0 vs 4, 1 vs 3, 1 vs 4), (b) piecemeal necrosis score (0 vs 1, 0 vs 3), and (c) fibrosis score (0 vs 3, 0 vs 4, 1 vs 4, 0 vs 1). Corresponding P values adjusted for multiple comparisons are shown. (d) There were no significant differences between lobular inflammation scores.

Figure 2a:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2b:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2c:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2d:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2e:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2f:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2g:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2h:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2i:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2j:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2k:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 2l:

Histologic correspondence with PET images of hepatic 18F fluorocholine uptake. Images were obtained in four patients with increasing clinical liver disease severity. Arrows indicate liver tumors. Normal kidneys (k) show physiologically high uptake of 18F fluorocholine. (a–c) Images in a 79-year-old man with no history of hepatitis show normal portal areas without fibrosis (Metavir stage, F0) on Masson trichrome–stained liver slice (a) and no substantial inflammation on hematoxylin-eosin–stained liver slice (b), resulting in a Knodell score of 2. Corresponding maximum intensity projection PET image of the upper abdomen (c) shows physiologic liver uptake, with a mean standardized uptake value (SUVmean) of 10.2. (d–f) Images in a 55-year-old man with hepatitis C virus (HCV) infection show focal necrosis with inflammation (original magnification, ×400) on hematoxylin-eosin–stained slice (d) and fibrous expansion of portal areas (Metavir stage, F1) on Masson trichrome–stained liver slice (e), resulting in a Knodell score of 5. Corresponding maximum intensity projection image (f) shows liver uptake (SUVmean, 8.3) is decreased in comparison with c (rendered at the same intensity scale, as shown to the right of c and f). (g–i) Images in a 59-year-old man with HCV. Substantial portal inflammation on hematoxylin-eosin–stained slice (g) and bridging fibrosis (Metavir stage, F2) on Masson trichrome–stained liver slice (h), resulting in a Knodell score of 7. Corresponding maximum intensity projection image (i) shows moderately diminished liver SUVmean of 7.6. (j–l) Images in a 64-year-old man with HCV infection show necrosis with ballooning hepatocytes (original magnification, ×400) on hematoxylin-eosin–stained slice (j) and cirrhosis (Metavir stage, F4) on Masson trichrome–stained liver slice (k), resulting in a Knodell score of 14. Corresponding maximum intensity projection image (l) shows severely diminished liver uptake, with SUVmean of 5.4.

Figure 3:

Liver mean standardized uptake values (SUVmean) at different Metavir stages of fibrosis. Error bars indicate standard error above and below the mean. P values for pairwise comparisons were adjusted for multiple comparisons.