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Evaluation of FDG Uptake by Renal Malignancies (Primary Tumor or Metastases) Using a Coincidence Detection Camera

Services de Médecine Nucléaire, d'Urologie, et de Néphrologie A et B, Hôpital Tenon, Paris, France

Correspondence: For correspondence or reprints contact: Françoise Montravers, MD, Service de Médecine Nucléaire, Hôpital Tenon, 4 rue de la Chine, F-75020 Paris, France.

ABSTRACT

The aim of this study was to evaluate the usefulness of FDG scanning using an ordinary camera equipped with coincidence detection (CDET) for 2 renal cancer indications: characterization and staging of renal masses before nephrectomy and search for recurrence after nephrectomy. Methods: Between September 1997 and June 1998, a whole-body scan and at least 1 tomoscintigram were obtained on 23 occasions in 22 patients (fasting for at least 6 h) using a Prism XP 2000 CDET camera; scanning was begun 45 min after intravenous injection of 150–250 MBq FDG. Results: Postoperative histologic evidence was obtained from 13 of 16 patients who underwent FDG using a CDET camera before renal surgery; 4 renal masses did not accumulate FDG (3 true-negatives, 1 false-negative), whereas 9 renal tumors accumulated FDG (8 true-positives, 1 false-positive). In the other 3 patients, only 1 extrarenal site of FDG uptake was checked and confirmed on histologic examination: a bone metastasis from renal cell carcinoma in 2 cases and lymph node metastasis from a squamous cell carcinoma (3 true-positives). The primary local and regional staging of the malignant renal tumors was accurate in the 9 patients who underwent nephrectomy (8 true-negatives, 1 true-positive). The primary distant staging was positive in 1 case (focus in the chest corresponding to a probable true-positive on follow-up). In the 7 examinations performed because of suspected recurrence of renal cell carcinoma several months after nephrectomy, metastases were visualized by FDG in 4 patients, confirmed by biopsy in 2 patients, and confirmed by conventional imaging or follow-up (or both) in 2 patients. The other 3 patients had negative FDG scans, corresponding to probable true-negative results on follow-up. Conclusion: FDG using a CDET camera can be used effectively for the staging and restaging of renal tumors and might be useful for characterization of the primary renal tumor in doubtful cases.

Key Words: renal cancer • FDG • coincidence detection • camera

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