Departments of Nuclear Medicine.
Urology.
Nucl Med Commun. 2020 May;41(5):485-493. doi: 10.1097/MNM.0000000000001169.
The primary objective of the study was to evaluate the correlation between semi-quantitative F-18 FDG PET parameters and renal cell carcinoma (RCC) grade and its role in predicting the histopathological grade in RCC. The secondary objective was to evaluate the role of forced diuresis in improving the diagnostic accuracy of F-18 FDG for RCC.
Thirty-three patients with radiologically proven RCC were included in the study. All patients underwent PET/CT on a dedicated PET/CT scanner (Biograph mCT; Siemens Medical Solutions, Erlangen, Germany) 45-60 min post-injection F-18-FDG. Patients were then injected 1 mg/kg body weight furosemide (upto 40 mg) and regional PET/CT images of abdomen were acquired after 2 h. For both baseline and post-diuretic F-18-FDG PET/CT scans, maximum standardized uptake value for tumor (SUVmax), mean SUV for tumor, metabolic tumor volume (MTV), tumor-to-liver (T/L) and tumor-to-kidney ratio (T/K) were calculated. Histopathology findings were considered as the reference standard. To assess the incremental value of diuresis in scan interpretation, visual analysis of scans was done.
Of 33 patients, histopathology grading was available for comparison with metabolic tumor markers in all except four. Of 29 patients (mean age = 51.89 ± 13.54 years), 20 patients had clear cell (cc) type while rest had non-cc RCC. Difference between the mean values among the categories was insignificant for all parameters except T/K. Fuhrman grading was obtained in 25 patients (17 low and eight high). SUVmax, MTV and T/L were found to be significantly different between low and high grade patients. Significantly strong positive correlation was observed between Furhman grades and tumor metabolism (r ≥ 0.5). No significant difference was observed between baseline and post-diuretic scan in any of the patients.
Semi-quantitative F-18 FDG PET parameters (SUVmax, MTV and T/L) were found to be significantly correlated with Fuhrman grade in patients with RCC and are important markers for differentiation between low- and high-grade tumors. Furthermore, forced diuresis had no incremental value in characterization of primary RCC lesions.
本研究的主要目的是评估半定量 F-18 FDG PET 参数与肾细胞癌 (RCC) 分级之间的相关性及其在预测 RCC 组织学分级中的作用。次要目的是评估强制利尿在提高 F-18 FDG 诊断 RCC 中的作用。
本研究纳入了 33 例经影像学证实的 RCC 患者。所有患者均在专用 PET/CT 扫描仪（Siemens Medical Solutions 公司的 Biograph mCT）上进行 PET/CT 检查，注射 F-18-FDG 后 45-60 分钟。然后，患者静脉注射 1mg/kg 体重呋塞米（最高 40mg），2 小时后采集腹部局部 PET/CT 图像。对于基线和利尿后 F-18-FDG PET/CT 扫描，计算肿瘤的最大标准化摄取值（SUVmax）、肿瘤平均 SUV、代谢肿瘤体积（MTV）、肿瘤与肝脏比值（T/L）和肿瘤与肾脏比值（T/K）。组织病理学发现被视为参考标准。为了评估利尿在扫描解释中的增量价值，对扫描进行了视觉分析。
在 33 例患者中，除 4 例外，所有患者的组织病理学分级均与代谢肿瘤标志物进行了比较。在 29 例患者（平均年龄=51.89±13.54 岁）中，20 例为透明细胞（cc）型，其余为非 cc RCC。除 T/K 外，所有参数的类别之间的平均值差异均无统计学意义。在 25 例患者中获得了 Fuhrman 分级（17 例低分级和 8 例高分级）。SUVmax、MTV 和 T/L 在低分级和高分级患者之间存在显著差异。肿瘤代谢与 Furhman 分级之间存在显著的正相关（r≥0.5）。在任何患者中，基线和利尿后扫描之间均无显著差异。
在 RCC 患者中，半定量 F-18 FDG PET 参数（SUVmax、MTV 和 T/L）与 Fuhrman 分级显著相关，是低级别和高级别肿瘤之间区分的重要标志物。此外，强制利尿对原发性 RCC 病变的特征描述没有额外的价值。
