Tzortzakakis Antonios, Gustafsson Ove, Karlsson Mattias, Ekström-Ehn Linnea, Ghaffarpour Rammin, Axelsson Rimma
Radiology Department, Division of Medical Imaging and Technology, Karolinska University Hospital, C1-46, SE-141 86, Huddinge, Stockholm, Sweden.
Division of Urology, Karolinska University Hospital, Huddinge, Sweden.
EJNMMI Res. 2017 Dec;7(1):29. doi: 10.1186/s13550-017-0278-z. Epub 2017 Mar 29.
Despite the progress in the quality of multiphasic CT and MRI scans, it is still difficult to fully characterize a solid kidney lesion. Approximately 10% of all solid renal tumours turn out to be oncocytomas. In actual clinical practice, this is verified only following unnecessary surgery or a renal biopsy/ablation. The objective of our pilot study examines whether Tc-sestamibi SPECT/CT can play a crucial role in the characterization of solid renal neoplasms and the differentiation of oncocytomas from renal cell carcinomas. The study included 27 patients identified with 31 solid renal lesions. All patients were discussed in a multidisciplinary conference, and a decision for surgery or biopsy was taken. Prior to invasive procedures, patients underwent a SPECT/CT with Tc-sestamibi. Visual evaluation was performed, and any focal Tc-sestamibi uptake detected on SPECT in the localisation of tumour was considered as positive.
Eleven out of 12 oncocytomas (91.6%) displayed positive uptake of Tc-sestamibi. Three hybrid tumours (mixed-type oncocytoma and chromophobe renal cancer) were positive on SPECT/CT. One papillary renal cell carcinoma had a slight uptake of Tc-sestamibi. The remaining 11 renal cell carcinomas were sestamibi negative.
Differentiation of benign renal oncocytomas from renal cell carcinomas seems very promising on Tc-sestamibi SPECT/CT examination. Additional supplement to visual evaluation, i.e. quantitative tools, should be sought for an accurate estimate of biological behaviour and hence a secure diagnosis.
尽管多期CT和MRI扫描质量有所进步，但仍难以全面表征实性肾病变。所有实性肾肿瘤中约10%最终被证实为嗜酸细胞瘤。在实际临床实践中，这只有在进行了不必要的手术或肾活检/消融后才能得到证实。我们的初步研究目的是检验锝-司他比SPECT/CT在实性肾肿瘤表征以及嗜酸细胞瘤与肾细胞癌鉴别诊断中是否能发挥关键作用。该研究纳入了27例发现有31个实性肾病变的患者。所有患者均在多学科会议上进行了讨论，并做出了手术或活检的决定。在进行侵入性操作之前，患者接受了锝-司他比SPECT/CT检查。进行了视觉评估，在SPECT上肿瘤定位处检测到的任何局灶性锝-司他比摄取均被视为阳性。
12例嗜酸细胞瘤中有11例（91.6%）显示锝-司他比摄取阳性。3例混合性肿瘤（混合型嗜酸细胞瘤和嫌色性肾癌）在SPECT/CT上呈阳性。1例乳头状肾细胞癌有轻微的锝-司他比摄取。其余11例肾细胞癌锝-司他比呈阴性。
在锝-司他比SPECT/CT检查中，鉴别良性肾嗜酸细胞瘤与肾细胞癌似乎很有前景。应寻求视觉评估的额外补充，即定量工具，以准确估计生物学行为，从而确保诊断。
