A new study has demonstrated the ability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to classify intrahepatic cholangiocarcinoma (ICC) and predict microvascular invasion.

The study, published in Quantitative Imaging in Medicine and Surgery, offers a potential noninvasive biomarker for individualized treatment decisions in patients with primary liver cancers.

“Positron emission tomography/computed tomography (PET/CT)-based radiomics combined with medical imaging and molecular imaging could potentially be used to investigate predictive or prognostic biomarkers for tumor diagnosis, treatment, efficacy evaluation, and prognosis prediction before surgery,” the authors explained.

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“We attempted to explore 18F-FDG PET/CT imaging’s potential capability in the auxiliary diagnosis of its additional application in [hepatocellular carcinoma (HCC)] and ICC classification, as well as detection of [microvascular invasion] presence before surgery.”

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The research team conducted a retrospective study of 112 patients with liver cancer who underwent 18F-FDG PET/CT scans between January 2016 and December 2019 at a single center in Shanghai, China. In total, 1815 radiomics features reflecting tumor characteristics were extracted for each patient, including 897 PET features and 918 CT features. Based on this dataset, the authors employed feature engineering to create a predictive model for microvascular invasion and the classification of HCC and ICC.

The team found that PET features were able to predict HCC and ICC classification as well as the presence of microvascular invasion to a greater degree than CT and tumor clinical characteristics. Notably, the authors’ model was equivalent or superior to contrast-enhanced ultrasound in classifying HCC and ICC and in predicting microvascular invasion, suggesting that 18F-FDG PET/CT has significant value for patients before surgery in terms of selecting the optimal treatment approach.

The team hopes this new biomarker will help guide clinicians as they establish personalized treatments for their patients.


Jiang C, Zhao L, Xin B, Ma G, Wang X, Song S. 18F-FDG PET/CT radiomic analysis for classifying and predicting microvascular invasion in hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Quant Imaging Med Surg. 2022;12(8):4135-4150. doi:10.21037/qims-21-1167