Abstract
291
Objectives The purpose was to determine the diagnostic performance of F-18 FDG PET after administration of diuretic for upper urinary tract carcinomas by comparing between non-contrast method (non-contrast PET/CT (PET/pCT) or PET/MRI fusion) and contrast-enhanced method (contrast-enhanced CT (ceCT) or PET/CT (PET/ceCT)).
Methods Twenty-four consecutive patients with known bladder cancer (n=16) and positive urinary cytology without bladder lesion (n=8) underwent PET/CT and MRI. After whole-body PET/CT scan, Furosemide was administrated 120 minutes after FDG injection. Delayed PET/CT was performed after an uptake phase of 180 min, followed by ceCT. All the patients underwent MRI including diffusion-weighted images within three days. PET/MRI fusion was retrospectively constructed by using a software. To determine the diagnostic performance for upper urinary tract lesions, ceCT, PET/pCT, PET/ceCT, MRI and PET/MRI were separately and visually assessed for 10 divided regions of each upper urinary tract by using a 5-point scoring system. The ROC analysis followed by the McNemar’s test were performed based on the reference standard determined by the histopathological results.
Results 16 upper urinary tract carcinomas in 480 regions were determined by the reference standard. Although one carcinoma was detected only by ceCT, there was no significant difference in diagnostic performance between non-contrast and contrast-enhanced method (p>0.05). Number of equivocal scoring was significantly lower with PET/MRI than PET/pCT (<0.05).
Conclusions Diagnostic performance of non-contrast F-18 FDG PET/CT and PET/MRI after diuretic is equivalent to contrast-enhanced methods, suggesting contrast material and additional radiation exposure could be avoided for diagnosis of upper urinary tract carcinoma. Although additional value of PET/MRI fusion is limited, diagnostic confidence is improved.
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