Publication date: Jun 24, 2025

Hepatocellular carcinoma (HCC) is a highly prevalent malignant tumor worldwide, with Chinese patients accounting for more than 50%. Microvascular invasion (MVI) is a significant risk factor for postoperative recurrence of HCC. 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT), as a hybrid imaging modality integrating metabolic information from PET with anatomical details from CT. This combined approach enables simultaneous assessment of glucose metabolism and structural features. It can also evaluate tumor biological behavior through metabolic parameters and heterogeneity characteristics. To explore the predictive value of 18F-FDG PET/CT metabolic parameters and heterogeneity index for MVI in HCC patients before liver transplantation and to construct a nomogram prediction model. A retrospective study involving 177 HCC patients who underwent liver transplantation (100 MVI-positive cases and 77 MVI-negative cases) was conducted to analyze the correlation between clinical characteristics, PET/CT metabolic parameters (SUVmax, SUVmean, TLG, and TLR), and heterogeneity parameters (COV and HI) with MVI. Independent predictors were identified using univariate and multivariate logistic regression, and a nomogram model was constructed. The model’s performance was evaluated using calibration curves and ROC curves. Univariate analysis showed significant differences in PIVKA-II, SUVmax, TLG, TLR, COV, and HI between the two groups (all P 

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