Shimamoto Tsutomu, Karashima Takashi, Nogami Munenobu, Inoue Keiji, Yamagami Takuji
Department of Urology, Kochi Medical School, Nankoku, JPN.
Department of Radiology, Kobe University, Kobe, JPN.
Cureus. 2024 Aug 29;16(8):e68160. doi: 10.7759/cureus.68160. eCollection 2024 Aug.
Previous reports attempted to evaluate bladder cancer using 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) by washing out the excreted FDG with a diuretic. The purpose of this study was to evaluate the value of diuretic FDG PET/plain CT (drtPET/CT) and diuretic FDG PET/contrast-enhanced CT (drtPET/ceCT) in the assessment of upper urinary tract cancers.
A total of 66 patients underwent drtPET/CT for suspected upper urinary tract cancer (UUTC). The study targeted 29 patients who were strongly suspected of having UUTC and underwent magnetic resonance imaging (MRI) of the upper urinary tract. A total of 29 (24 male, five female) patients, with a mean ± SD age of 73 ± 3 (range, 43-84) years, had a suspected neoplasm in the upper urinary tract. They underwent FDG PET/plain and contrast-enhanced CT before and after a diuretic and MRI including diffusion-weighted imaging (DWI). A urologist and a physician board-certified in nuclear medicine and radiology independently interpreted the standard PET/CT (stdPET/CT), drtPET/CT, drtPET/ceCT, ceCT, and MRI with DWI images. Interobserver agreement and the diagnostic performance of each modality were evaluated.
The kappa values of stdPET/CT, drtPET/CT, drtPET/ceCT, ceCT, and MRI were 0.381, 0.567, 0.7031, 0.448, and 0.185, respectively, with drtPET/ceCT showing the highest kappa value and the only one with good interobserver agreement (>60%). The area under the curve of drtPET/ceCT was 0.92, which was significantly higher than those of stdPET/CT (P=0.027) and MRI (P=0.047).
In the present study, drtPET/ceCT had the best diagnostic performance and the highest interobserver agreement for detecting upper urinary tract urothelial cancers.
既往报告试图通过使用利尿剂冲洗排泄出的18F-氟脱氧葡萄糖（FDG），利用18F-FDG正电子发射断层扫描/计算机断层扫描（PET/CT）来评估膀胱癌。本研究的目的是评估利尿FDG PET/平扫CT（drtPET/CT）和利尿FDG PET/增强CT（drtPET/ceCT）在上尿路癌评估中的价值。
共有66例疑似上尿路癌（UUTC）患者接受了drtPET/CT检查。该研究针对29例高度怀疑患有UUTC且接受过上尿路磁共振成像（MRI）检查的患者。共有29例（24例男性，5例女性）患者，平均年龄±标准差为73±3岁（范围43 - 84岁），上尿路存在疑似肿瘤。他们在使用利尿剂前后分别接受了FDG PET/平扫和增强CT检查以及包括扩散加权成像（DWI）在内的MRI检查。一名泌尿科医生以及一名拥有核医学和放射学专业认证的内科医生独立解读标准PET/CT（stdPET/CT）、drtPET/CT、drtPET/ceCT、增强CT（ceCT）以及带有DWI图像的MRI。评估了观察者间的一致性以及每种检查方式的诊断性能。
stdPET/CT、drtPET/CT、drtPET/ceCT、ceCT和MRI的kappa值分别为0.381、0.567、0.7031、0.448和0.185，其中drtPET/ceCT的kappa值最高，且是唯一观察者间一致性良好（>60%）的检查方式。drtPET/ceCT的曲线下面积为0.92，显著高于stdPET/CT（P = 0.027）和MRI（P = 0.047）。
在本研究中，drtPET/ceCT在检测上尿路尿路上皮癌方面具有最佳的诊断性能和最高的观察者间一致性。
