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Forced Diuresis Improves the Diagnostic Accuracy of ¹⁸F-FDG PET in Abdominopelvic Malignancies

¹ Department of Nuclear Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; ² Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; ³ Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; and ⁴ Department of Gynaecology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Correspondence: For correspondence or reprints contact: Ehab M. Kamel, MD, Nuclear Medicine, University Hospital, CH-1011 Lausanne, Switzerland. E-mail: Mohamed-Ehab.Kamel{at}chuv.ch

Our aim was to evaluate the role of forced diuresis in improving the diagnostic accuracy of abdominopelvic ¹⁸F-FDG PET. Methods: Thirty-two patients were enrolled. Besides the presence of known intravesical tumors or undefined renal lesions on the initial PET scan, the inclusion criterion was the appearance of indeterminate or equivocal ¹⁸F-FDG foci that extended along the course of the urinary tract and could not confidently be separated from urinary activity. For each patient, a second abdominopelvic PET study was performed after intravenous injection of 0.5 mg of furosemide per kilogram of body weight (maximum, 40 mg) coupled with parenteral infusion of physiologic saline. Results: Forced diuresis coupled with parenteral hydration eliminated any significant ¹⁸F-FDG activity from the lower urinary tract in 31 (97%) of 32 patients after the bladder had been voided 3 successive times. Twelve intravesical lesions were visualized with outstanding clarity, whereas radiologic suspicion of locally recurrent bladder tumors was ruled out in 3 patients. Among 14 indeterminate or equivocal extravesical foci, 7 were deemed of no clinical value because they disappeared after furosemide challenge, whereas 7 persisting foci were proven to be true-positive PET findings. The performance of ¹⁸F-FDG PET in characterizing 3 renal-space–occupying lesions could not be improved by our protocol. Conclusion: Furosemide challenge has the potential to noninvasively resolve the inherent ¹⁸F-FDG contrast handicap in the lower urinary tract.

Key Words: ¹⁸F-FDG PET/CT • forced diuresis • bladder cancer

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