Anjos Dalton A, Etchebehere Elba C S C, Ramos Celso D, Santos Allan O, Albertotti César, Camargo Edwaldo E
Division of Nuclear Medicine and PET/CT, Sírio-Libanês Hospital, São Paulo, Brazil.
J Nucl Med. 2007 May;48(5):764-70. doi: 10.2967/jnumed.106.036350.
PET with (18)F-FDG has been considered of limited value for detection of bladder cancer because of the urinary excretion of the tracer. The purpose of this study was to investigate the role of PET/CT in the detection and restaging of bladder cancer using furosemide and oral hydration to remove the excreted (18)F-FDG from the bladder.
Seventeen patients with bladder cancer (11 without cystectomy, 6 with total cystectomy and urinary diversion) underwent (18)F-FDG PET/CT from head to the upper thighs 60 min after the intravenous injection of 370 MBq of (18)F-FDG. Additional pelvic images were acquired 1 h after the intravenous injection of furosemide and oral hydration. PET/CT findings were confirmed by MRI, cystoscopy, or biopsy.
PET/CT was able to detect bladder lesions in 6 of 11 patients who had not undergone cystectomy. These images changed the PET/CT final reading in 7 patients: Recurrent bladder lesions were detected in 6 patients, pelvic lymph node metastases in 2 patients, and prostate metastasis in 1. This technique overcame the difficulties posed by the urinary excretion of (18)F-FDG. Hypermetabolic lesions could be easily detected by PET and precisely localized in the bladder wall, pelvic lymph nodes, or prostate by CT. Seven of 17 patients (41%) were upstaged only after delayed pelvic images.
Detection of locally recurrent or residual bladder tumors can be dramatically improved using (18)F-FDG PET/CT with delayed images after a diuretic and oral hydration.
由于示踪剂经尿液排泄，(18)F-FDG正电子发射断层显像（PET）在膀胱癌检测中的价值一直被认为有限。本研究的目的是探讨PET/CT在膀胱癌检测及再分期中的作用，采用速尿和口服补液以清除膀胱内排泄出的(18)F-FDG。
17例膀胱癌患者（11例未行膀胱切除术，6例接受全膀胱切除术及尿流改道术）在静脉注射370MBq的(18)F-FDG后60分钟接受从头至大腿上部的(18)F-FDG PET/CT检查。在静脉注射速尿及口服补液1小时后获取额外的盆腔图像。PET/CT检查结果通过磁共振成像（MRI）、膀胱镜检查或活检得以证实。
PET/CT能够在11例未行膀胱切除术的患者中的6例检测到膀胱病变。这些图像改变了7例患者的PET/CT最终诊断结果：6例患者检测到复发性膀胱病变，2例患者检测到盆腔淋巴结转移，1例患者检测到前列腺转移。该技术克服了(18)F-FDG经尿液排泄所带来的困难。PET能够轻松检测到高代谢病变，CT能够将其精确地定位在膀胱壁、盆腔淋巴结或前列腺。17例患者中有7例（41%）仅在延迟盆腔图像检查后进行了分期上调。
使用(18)F-FDG PET/CT并在利尿及口服补液后获取延迟图像，可显著提高对局部复发性或残留膀胱肿瘤的检测能力。
