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Annals of Clinical and Analytical Medicine

ACAM
E-ISSN: 2667-663X · Monthly · English

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Investigating the FIB-4 index and PET/CT metabolic parameters for the differentiation status of hepatocellular carcinoma

FIB-4 index and PET/CT parameters in HCC

Original Research doi:10.4328/ACAM.50067 Published: 20.03.2026 Ann Clin Anal Med 2026;17(Suppl 2)

Authors

1, 2, 1, 3, 4
Affiliations

1Department of Nuclear Medicine, Faculty of Medicine, Sakarya University, Research and Training Hospital, Sakarya, Türkiye.

2Department of Medical Oncology, Tekirdağ İsmail Fehmi Cumalıoğlu City Hospital, Tekirdağ, Türkiye.

3Department of Nuclear Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye.

4Department of Nuclear Medicine, Ağrı Training and Research Hospital, Ağrı, Türkiye.

Corresponding Author

Esra Çiftci

esraciftci@sakarya.edu.tr

+90 506 386 64 65

Declarations

Ethics Declarations

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and its subsequent amendments. All procedures were performed in line with institutional and national ethical standards. The study protocol was reviewed and approved by the Ethics Committee of Sakarya University Faculty of Medicine (Date: 20.02.2025, Decision No: E-450939/116).

Animal and Human Rights Statement

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was waived due to the retrospective design of the study.

Data Availability

The datasets used and/or analyzed during the current study are not publicly available due to patient privacy reasons but are available from the corresponding author on reasonable request.

Conflict of Interest

The authors declare that there is no conflict of interest.

Funding

None.

Author Contributions (CRediT Taxonomy)

Conceptualization: E.C.

Methodology: E.C., B.G.

Formal Analysis: E.C., B.A.

Investigation: H.S.G., B.A.

Data Curation: H.S.G., B.A.

Writing – Original Draft Preparation: E.C., B.K.E.

Writing – Review & Editing: E.C., B.A., B.G.

Supervision: E.C., B.G.

References

  1. Yin Y, Liu J, Sun R, et al. Exploring the efficacy of 18F-FDG PET/CT in hepatocellular carcinoma diagnosis: role of Ki-67 index and tumor differentiation. Abdom Radiol (NY). 2023;48(11):3408-3419. doi:10.1007/s00261-023-04027-4
    Article PubMed Google Scholar
  2. Benson AB, D'Angelica MI, Abbott DE, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2021;19(5):541-565. doi:10.6004/jnccn.2021.0022
    Article PubMed Google Scholar
  3. Jiang S, Gao X, Tian Y, et al. The potential of 18F-FDG PET/CT metabolic parameter-based nomogram in predicting the microvascular invasion of hepatocellular carcinoma before liver transplantation. Abdom Radiol (NY). 2024;49(5):1444-1455. doi:10.1007/s00261-023-04166-8
    Article PubMed Google Scholar
  4. Arshad K, Hanan SD, Younis MN, et al. Detection of Primary Hepatocellular Carcinoma on 18F-Fluorodeoxyglucose Positron Emission Tomography-computed Tomography. Euroasian J Hepatogastroenterol. 2023;13(2):66-72. doi:10.5005/jp-journals-10018-1409
    Article PubMed Google Scholar
  5. Lv J, Yin H, Mao W, Shi H. Investigating the value of pre-treatment 18F-FDG PET/CT in predicting the pathological characteristic of hepatocellular carcinoma and recurrence after liver transplantation. Abdom Radiol (NY). 2021;46(6):2490-2497. doi:10.1007/s00261-020-02872-1
    Article PubMed Google Scholar
  6. Xia H, Chen J, Gao H, et al. Hypoxia-induced modulation of glucose transporter expression impacts 18F-fluorodeoxyglucose PET-CT imaging in hepatocellular carcinoma. Eur J Nucl Med Mol Imaging. 2020;47(4):787-797. doi:10.1007/s00259-019-04638-4
    Article PubMed Google Scholar
  7. Kim M, Lee Y, Yoon JS, et al. The FIB-4 index is a useful predictor for the development of hepatocellular carcinoma in patients with coexisting nonalcoholic fatty liver disease and chronic hepatitis B. Cancers (Basel). 2021;13(10):2301. doi:10.3390/cancers13102301
    Article PubMed Google Scholar
  8. Ciftci E, Turgut B, Cakmakcilar A, Erturk SA. Diagnostic importance of 18F-FDG PET/CT parameters and total lesion glycolysis in differentiating between benign and malignant adrenal lesions. Nucl Med Commun. 2017;38(9):788-794. doi:10.1097/MNM.0000000000000712
    Article PubMed Google Scholar
  9. Boellaard R, Delgado-Bolton R, Oyen WJ, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42(2):328-354. doi:10.1007/s00259-014-2961-x
    Article PubMed Google Scholar
  10. Sabaté-Llobera A, Mestres-Martí J, Reynés-Llompart G, et al. 2-[18F]FDG PET/CT as a predictor of microvascular invasion and high histological grade in patients with hepatocellular carcinoma. Cancers (Basel). 2021;13(11):2554. doi:10.3390/cancers13112554
    Article PubMed Google Scholar
  11. Sun DW, An L, Wei F, et al. Prognostic significance of parameters from pretreatment (18)F-FDG PET in hepatocellular carcinoma: a meta-analysis. Abdom Radiol (NY). 2016;41(1):33-41. doi:10.1007/s00261-015-0603-9
    Article PubMed Google Scholar
  12. Seko Y, Yano K, Takahashi A, et al. The appropriate opportunity for evaluating liver fibrosis by using the FIB-4 index in patients with nonalcoholic fatty liver disease in Japan. Diagnostics (Basel). 2020;10(10):842. doi:10.3390/diagnostics10100842
    Article PubMed Google Scholar
  13. Li X, Xu H, Gao P. Fibrosis index based on 4 factors (FIB-4) predicts liver cirrhosis and hepatocellular carcinoma in chronic hepatitis C virus (HCV) patients. Med Sci Monit. 2019;25:7243-7250. doi:10.12659/MSM.918784
    Article PubMed Google Scholar
  14. Albhaisi S, Sun J, Sanyal AJ. Fibrosis-4 index is associated with the risk of hepatocellular carcinoma in patients with cirrhosis and nonalcoholic steatohepatitis. Front Oncol. 2023;13:1198871. doi:10.3389/fonc.2023.1198871
    Article PubMed Google Scholar
  15. Ito T, Kumada T, Toyoda H, Tada T. FIB-4 index for assessing the prognosis of hepatocellular carcinoma in patients with Child-Pugh class A liver function. J Cancer Res Clin Oncol. 2015;141(7):1311-1319. doi:10.1007/s00432-015-1922-5
    Article PubMed Google Scholar
  16. Feng JW, Qu Z, Wu BQ, Sun DL, Jiang Y. The preoperative fibrosis score 4 predicts posthepatectomy liver failure in patients with hepatocellular carcinoma. Ann Hepatol. 2019;18(5):701-707. doi:10.1016/j.aohep.2019.04.017
    Article PubMed Google Scholar
  17. Tian YB, Niu H, Xu F, Shang-Guan PW, Song WW. ALBI score combined with FIB-4 index to predict post-hepatectomy liver failure in patients with hepatocellular carcinoma. Sci Rep. 2024;14(1):8034. doi:10.1038/s41598-024-58205-5
    Article PubMed Google Scholar
  18. Sökmen BK, Inan N. 18 F-FDG PET/MRI of primary hepatic malignancies: differential diagnosis and histologic grading. Curr Med Imaging. 2024;20:e080523216636. doi:10.2174/1573405620666230508105758
    Article PubMed Google Scholar
  19. Abdelhalim H, Houseni M, Elsakhawy M, Elabd OM. Role of 18F-FDG PET-CT in initial staging of hepatocellular carcinoma and its impact on changing clinical decision. Egyptian Liver Journal. 2020;10(1):3. doi:10.1186/s43066-019-0012-9
    Article PubMed Google Scholar
  20. Ghidaglia J, Golse N, Pascale A, Sebagh M, Besson FL. 18F-FDG /18F-choline dual-tracer PET behavior and tumor differentiation in hepatocellular carcinoma. a systematic review. Front Med (Lausanne). 2022;9:924824. doi:10.3389/fmed.2022.924824
    Article PubMed Google Scholar
  21. Lee JD, Yun M, Lee JM, et al. Analysis of gene expression profiles of hepatocellular carcinomas with regard to 18F-fluorodeoxyglucose uptake pattern on positron emission tomography. Eur J Nucl Med Mol Imaging. 2004;31(12):1621-1630. doi:10.1007/s00259-004-1602-1
    Article PubMed Google Scholar
  22. Yamamoto Y, Nishiyama Y, Kameyama R, et al. Detection of hepatocellular carcinoma using 11C-choline PET: comparison with 18F-FDG PET. J Nucl Med. 2008;49(8):1245-1248. doi:10.2967/jnumed.108.052639
    Article PubMed Google Scholar
  23. Talbot JN, Gutman F, Fartoux L, et al. PET/CT in patients with hepatocellular carcinoma using [(18)F]fluorocholine: preliminary comparison with [(18)F]FDG PET/CT. Eur J Nucl Med Mol Imaging. 2006;33(11):1285-1289. doi:10.1007/s00259-006-0164-9
    Article PubMed Google Scholar

About This Article

How to Cite This Article

Esra Çiftci, Burcu Gülbağcı, Hatice Sarıyıldız Gümüşgöz, Burak Akovalı, Burçin Karasah Erkek. Investigating the FIB-4 index and PET/CT metabolic parameters for the differentiation status of hepatocellular carcinoma. Ann Clin Anal Med 2026;17(Suppl 2). doi:10.4328/ACAM.50067

Supplementary Tables

Publication History

Received:
05.02.2026
Accepted:
11.03.2026
Published Online:
11.03.2026
Printed:
20.03.2026