1Department of Nuclear Medicine, Faculty of Medicine - Cairo University
2Assistant Professor of Radiology, National Liver Institute - Menoufya University
Background: Liver cirrhosis alters hepatic metabolism and FDG uptake, which may affect the reliability of using the liver as a reference in PET/CT interpretation.
Aim: To assess hepatic metabolic and volumetric parameters on 18F-FDG PET/CT in advanced cirrhosis versus normal liver, identify key differences, and propose correction factors for accurate semiquantitative analysis.
Patients and methods: This was prospective comparative research involving 114 adult patients with different extrahepatic malignancies who presented for PET/CT for staging or restaging of their malignant process to Kasr Al-Ainy Hospital, Cairo University, in the period from October 2022 to August 2024. Patients were divided into two groups: Group I included individuals with no liver disease history and normal liver appearance on CT; Group II included patients with a long-standing history of cirrhosis and CT features of advanced liver disease, regardless of cause.
Results: Cirrhotic cases had a mean age of 63.9 years and were mostly female. CT confirmed advanced cirrhosis features, with splenomegaly in 60%. Using the whole liver ROI, SUVmean was significantly lower in cirrhotics (1.82 ± 0.3) vs. controls (2.4 ± 0.51), p < 0.001, while SUVmax illustrated insignificant variance. Cirrhotics also had significantly lower functional liver volume, GHG, and HU. Blood pool SUVmean was similar between groups, but the liver/BP SUVmean ratio was lower in cirrhotics. Suggested correction factors for SUVmean are 1.89 (<1.5), 1.33 (1.5–2), and 1.09 (>2).
Conclusion: In advanced cirrhosis, whole liver ROI is more accurate. SUVmean is lower, other liver measures reduced, especially with ascites. Correction factors are advised for SUVmean.
Keywords: Liver cirrhosis, FDG PET/CT, SUVmean, Semiquantitative analysis
How to cite this article: awfiq AMM, Wagih S, Houseni M, Tawakol A, Salama M, Impact of Advanced Liver Cirrhosis on Hepatic Metabolic Parameters and Volumetric Measurements Using 18F-FDG PET/CT. Int J Drug Deliv Technol. 2026;16(5s): 813-823. DOI: 10.25258/ijddt.16.5s.96
Source of support: None
Conflict of interest: None