We investigated the predictive value of fluorine-18-fluorodenoxyglucose positron emission tomography/computed tomography for pathological malignant potential and early recurrence of hepatocellular carcinoma (HCC) after resection. From April 2006 to October 2009, 53 patients with naïve HCC were enrolled. Accumulations of 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) standardized uptake value (SUVmax) in both HCC and non-HCC areas of the liver as well as the ratio of SUVmax (R-SUV; HCC/liver) were calculated. The results were evaluated to determine prognostic factors for early recurrence. One patient was graded as tumor node metastasis stage I, 35 as II, 14 as III and 3 as stage IV. Elevated protein induced by vitamin K absence or antagonist II (≥200 mAU/ml) as well as elevated fucosylated α-fetoprotein (≥15%), tumor size (≥5 cm) and high R-SUV (≥1.5) were risk factors for early recurrence in a univariate analysis (P<0.05). In a multivariate analysis, high R-SUV (≥1.5) was the only risk factor (P<0.05). The recurrence-free rate in patients with low R-SUV (<1.5, n=34) was higher than that in those with high R-SUV (≥1.5, n=19) (1- and 2-year rates: 100 and 67%, 67 and 17%; respectively, P<0.01). Patients with Edmondson III showed higher R-SUV values than those with Edmondson I and II (3.0±1.8, 1.4±0.3 and 1.9±0.9, respectively, P<0.01), while those with micro-vascular invasion (vp)(+), micro-intrahepatic metastasis (im)(+) or non-boundary type showed higher R-SUV values than vp(-), im(-) and boundary type (3.6±2.4 vs. 2.0±0.9, 3.5±2.3 vs. 1.9±0.8 and 2.9±1.8 vs. 1.6±0.5, respectively, P<0.01). R-SUV is proposed to be a useful marker for the prediction of early recurrence of HCC after resection.

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