Mertens Laura S, Fioole-Bruining Annemarie, Vegt Erik, Vogel Wouter V, van Rhijn Bas Wg, Horenblas Simon
Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
Indian J Nucl Med. 2012 Jul;27(3):145-50. doi: 10.4103/0972-3919.112718.
The aim of this study was to evaluate the use of delayed pelvic (18)F-2-fluoro-2-deoxy-D-glucose-positron emission tomography combined with the computed tomography (FDG-PET/CT) imaging, according to a standardized protocol including, pre-hydration and forced diuresis, for the detection of primary bladder cancer.
We evaluated 38 consecutive patients with primary cT1-4 bladder cancer. They underwent standard FDG-PET/CT followed by delayed pelvic imaging after administration of 20 mg furosemide intravenously and extra oral water intake of 0.5 L. Two observers, blinded for patient data, scored both image sets for tumor visibility using a 3-point ordinal scale: (1) negative; (2) indeterminate; (3) positive. FDG-PET/CT findings were compared with histopathology and/or follow-up imaging.
The procedure was completed successfully in 37/38 patients and the reference standard revealed a bladder tumor in 26/37 patients. Delayed PET/CT images showed reduction of urinary bladder activity to (near) background levels in 17 of 37 cases (45.9%). Standard PET/CT detected hyper-metabolic bladder lesions in 15/37 patients (40.5%) of which 8 were indeterminate. Delayed FDG-PET/CT showed hyper-metabolic bladder lesions in 30/37 (81.1%) patients, of which 5 were indeterminate. When indeterminate lesions were considered positive, the sensitivity of standard and delayed PET/CT was 46% versus 88%, respectively. The specificity was 72% versus 36%. When indeterminate lesions were considered negative, the sensitivity of standard and delayed PET/CT was 23% and 85%. The specificity was 93% versus 73%.
Our data suggest that delayed pelvic FDG-PET/CT imaging after forced detects more primary bladder tumors than standard FDG-PET/CT protocols. However, indeterminate bladder lesions on delayed PET/CT remain a problem and should be interpreted cautiously in order to avoid false positive results.
本研究旨在根据包括预水化和强制利尿的标准化方案，评估延迟盆腔（18）F - 2 - 氟 - 2 - 脱氧 - D - 葡萄糖 - 正电子发射断层扫描联合计算机断层扫描（FDG - PET/CT）成像用于检测原发性膀胱癌的情况。
我们评估了38例连续的原发性cT1 - 4期膀胱癌患者。他们接受了标准的FDG - PET/CT检查，随后静脉注射20mg呋塞米并额外经口摄入0.5L水后进行延迟盆腔成像。两名对患者数据不知情的观察者使用3分有序量表对两组图像的肿瘤可见性进行评分：（1）阴性；（2）不确定；（3）阳性。将FDG - PET/CT检查结果与组织病理学和/或后续成像进行比较。
38例患者中的37例成功完成了该检查，参考标准显示37例患者中有26例存在膀胱肿瘤。延迟PET/CT图像显示37例中有17例（45.9%）膀胱活动降至（接近）背景水平。标准PET/CT在37例患者中的15例（40.5%）检测到高代谢膀胱病变，其中8例不确定。延迟FDG - PET/CT在37例患者中的30例（81.1%）检测到高代谢膀胱病变，其中5例不确定。当将不确定病变视为阳性时，标准PET/CT和延迟PET/CT的敏感性分别为46%和88%。特异性分别为72%和36%。当将不确定病变视为阴性时，标准PET/CT和延迟PET/CT的敏感性分别为23%和85%。特异性分别为93%和73%。
我们的数据表明，强制利尿后延迟盆腔FDG - PET/CT成像比标准FDG - PET/CT方案能检测到更多的原发性膀胱肿瘤。然而，延迟PET/CT上的不确定膀胱病变仍然是一个问题，为避免假阳性结果应谨慎解读。
