PET/CT Center, Gansu Provincial Hospital, 204 West Donggang Road, Lanzhou, 730000, Gansu, China.
Department of Radiology, Gansu Provincial Hospital, Lanzhou, China.
Abdom Radiol (NY). 2017 May;42(5):1415-1423. doi: 10.1007/s00261-016-1030-2.
The aim of this retrospective study was to evaluate the role of delayed images after forced diuresis coupled with oral hydration in abdominopelvic F-FDG PET/CT.
Forty-six patients consisting of 17 urological diseases, 9 gynecological tumors, 18 colorectal malignancies, and 2 cancers of unknown primary site were retrospectively analyzed. All patients who presented with indeterminate or equivocal abdominopelvic foci on standard F-FDG PET/CT underwent a delayed abdominopelvic imaging after administration of 20 mg furosemide intravenously and extra water intake of 500 mL. PET/CT images before and after furosemide were compared with each other and their findings correlated with pathology or clinical follow-up (>6 months).
On initial PET/CT, the glucose metabolism characters of lesions were disguised by radioactive urine, or some undetermined F-FDG accumulating foci near the urinary tract appeared. While postdiuretic PET/CT demonstrated an excellent urinary tracer washout, and hypermetabolic lesions could be clearly detected and precisely localized in all cases. On the other hand, the suspected active foci caused by potential stagnation of excreted F-FDG in urinary tract were eliminated. The sensitivity, specificity, and accuracy were 94.4% (34/36), 8/10, 91.3% (42/46), respectively. Furthermore, the additional lesions with surrounding invasion or locoregional metastasis were discovered in 8 of 46 (17.4%) patients only by the delayed images, including 2 gynecological and 6 rectal malignancies.
Detection of abdominopelvic malignancies can be improved using delayed F-FDG PET/CT images after a diuretic and oral hydration.
本回顾性研究旨在评估利尿及口服水化后延迟显像在腹盆部 F-FDG PET/CT 中的作用。
本研究回顾性分析了 46 例患者，包括 17 例泌尿系统疾病、9 例妇科肿瘤、18 例结直肠恶性肿瘤和 2 例原发灶不明的癌症。所有标准 F-FDG PET/CT 检查结果显示腹盆部局灶性摄取不明确或可疑的患者，均在静脉注射 20mg 呋塞米和额外摄入 500ml 水后进行延迟腹盆部显像。比较呋塞米前后的 PET/CT 图像，并将其结果与病理或临床随访（>6 个月）相关联。
在初始 PET/CT 上，病变的葡萄糖代谢特征被放射性尿液掩盖，或在靠近泌尿道处出现一些不确定的 F-FDG 聚集灶。而利尿后 PET/CT 显示出极佳的尿示踪剂清除效果，所有病例均能清晰地检测到并准确定位高代谢病灶。另一方面，疑似因排泄 F-FDG 潜在停滞而导致的活跃病灶也被排除。其灵敏度、特异度和准确性分别为 94.4%（34/36）、8/10、91.3%（42/46）。此外，在 46 例患者中有 8 例（17.4%）仅通过延迟图像发现了周围侵犯或局部转移的附加病灶，包括 2 例妇科恶性肿瘤和 6 例直肠恶性肿瘤。
利尿及口服水化后行 F-FDG PET/CT 延迟显像可提高腹盆部恶性肿瘤的检出率。
