Imaging biomarkers related to 18F-FDG PET/CT for predicting microvascular invasion in hepatocellular carcinoma: a systematic review and meta-analysis
- 1Department of General Surgery, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, China
- 2Medical College, Wuhan University of Science and Technology, Wuhan, China
Abstract
Introduction: This study, through a meta-analysis, aimed to assess the predictive performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for microvascular invasion (MVI) in hepatocellular carcinoma (HCC).
Methods: Web of Science, Embase, PubMed, and Cochrane Library were comprehensively searched from database inception to January 13, 2026. EndNote 21was employed for literature screening and data extraction. Meta-analysis was carried out on the extracted data using Stata 15, MetaDisc 1.4, and MedCalc.
Results: In total, 21 studies were included, involving 2,023 patients with HCC, of whom 890 were MVI+ and 1,133 were MVI–. In univariable analyses, both tumor-to-normal liver uptake ratio (TLR) (odds ratio [OR] = 2.577, 95% confidence interval [CI]: 1.446–4.593, P = 0.001) and maximum standardized uptake value (SUVmax) (OR = 1.272, 95% CI: 1.036–1.561, P = 0.021) were significantly associated with an increased MVI risk. After multivariable adjustment, SUVmax retained independent predictive value (OR = 2.140, 95% CI: 1.244–3.681, P = 0.006), whereas the multivariable evidence for TLR was derived from a single study and required further validation. AUC values for SUVmax and radiomics score (Rad-score) were 0.819 (95% CI: 0.739–0.899) and 0.809 (95% CI: 0.762–0.857), respectively, with relatively balanced values for sensitivity, specificity, and negative likelihood ratio.
Conclusion: The available evidence supports SUVmax as one of the metabolic markers for preoperative MVI risk assessment in HCC, with Rad-score similar to SUVmax in diagnostic discrimination. The complementary value of the two markers was not demonstrated by this Meta-analysis, but rather derived from inferences proposed by external studies. Moreover, because the included radiomics studies did not report a pooled effect size for the combined model integrating SUVmax and Rad-score, a Meta-analysis targeting this model is currently not feasible. Therefore, the complementarity of SUVmax and Rad-score should be regarded as a hypothesis to be tested. In the future, multicenter, prospective radiomics studies with rigorous external validation are warranted to further explore a combined prediction model based on SUVmax and Rad-score. On this basis, an integrated assessment workflow should be gradually established, by which preoperative decisions are guided.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261289724.
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BibTeX
@article{li2026imaging,
title = {{Imaging biomarkers related to 18F-FDG PET/CT for predicting microvascular invasion in hepatocellular carcinoma: a systematic review and meta-analysis}},
author = {Zhigang Li and Ke Gong and Ning Liu},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1948193},
url = {https://doi.org/10.3389/fonc.2026.1948193},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Imaging biomarkers related to 18F-FDG PET/CT for predicting microvascular invasion in hepatocellular carcinoma: a systematic review and meta-analysis
AU - Zhigang Li
AU - Ke Gong
AU - Ning Liu
PY - 2026
DA - 2026/10/12
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1948193
UR - https://doi.org/10.3389/fonc.2026.1948193
AB - Introduction: This study, through a meta-analysis, aimed to assess the predictive performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Methods: Web of Science, Embase, PubMed, and Cochrane Library were comprehensively searched from database inception to January 13, 2026. EndNote 21was employed for literature screening and data extraction. Meta-analysis was carried out on the extracted data using Stata 15, MetaDisc 1.4, and MedCalc. Results: In total, 21 studies were included, involving 2,023 patients with HCC, of whom 890 were MVI+ and 1,133 were MVI–. In univariable analyses, both tumor-to-normal liver uptake ratio (TLR) (odds ratio [OR] = 2.577, 95% confidence interval [CI]: 1.446–4.593, P = 0.001) and maximum standardized uptake value (SUVmax) (OR = 1.272, 95% CI: 1.036–1.561, P = 0.021) were significantly associated with an increased MVI risk. After multivariable adjustment, SUVmax retained independent predictive value (OR = 2.140, 95% CI: 1.244–3.681, P = 0.006), whereas the multivariable evidence for TLR was derived from a single study and required further validation. AUC values for SUVmax and radiomics score (Rad-score) were 0.819 (95% CI: 0.739–0.899) and 0.809 (95% CI: 0.762–0.857), respectively, with relatively balanced values for sensitivity, specificity, and negative likelihood ratio. Conclusion: The available evidence supports SUVmax as one of the metabolic markers for preoperative MVI risk assessment in HCC, with Rad-score similar to SUVmax in diagnostic discrimination. The complementary value of the two markers was not demonstrated by this Meta-analysis, but rather derived from inferences proposed by external studies. Moreover, because the included radiomics studies did not report a pooled effect size for the combined model integrating SUVmax and Rad-score, a Meta-analysis targeting this model is currently not feasible. Therefore, the complementarity of SUVmax and Rad-score should be regarded as a hypothesis to be tested. In the future, multicenter, prospective radiomics studies with rigorous external validation are warranted to further explore a combined prediction model based on SUVmax and Rad-score. On this basis, an integrated assessment workflow should be gradually established, by which preoperative decisions are guided. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261289724.
SN - 2234-943X
ER -