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FIGURE 4 Tumor thrombus in the right hepatic vein (arrow) visualized by intraoperative ultrasonography.

FIGURE 5 A histologically confirmed metastatic lymph node in the para-aortic region (arrow) from a hepatocellular carcinoma in segment 7. A round node, 16 mm in diameter, was slightly enhanced in the periphery.

C cirrhosis (25). Fluorine 18 fluorodeoxyglucose (FDG) PET has a high average false-negative rate of 40% to 50% for the detection of HCC. The accumulation of FDG in HCC varies and depends on the activity of glucose-6-phosphatase, an enzyme that dephosphorylates intracellular FDG and allows it to be removed from the liver (26) (evidence Level 2b). The degree of FDG uptake in HCCs has also been shown to reflect tumor differentiation; well-differentiated HCCs have a low FDG uptake, which is distinguishable from that of benign lesions, while moderately or poorly differentiated HCCs have a high FDG uptake (27). FDG-PET is not commonly used as a screening tool for the detection of intrahepatic or extrahepatic HCC. Ho et al. reported that 11C-acetate, another radiotracer used for PET, had a high sensitivity and specificity for the detection of HCC when used in combination with FDG (28). Although the sensitivity of 11C-acetate does not appear to be as high as that of FDG, it may play a complementary role for the detection of HCC lesions that do not easily take up FDG (26).

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