Abstract
2706
Introduction: Urothelial carcinoma primarily arises in the bladder but can also occur in the portions of the upper urinary tract including renal pelvis and ureters and lower urinary tract including the urethra. Metastatic disease can also spread to the urinary tract and present similarly to primary urothelial cancers.
Upper urinary tract carcinoma (UUTC), although rare, typically have a poor prognosis due to early invasion into the surrounding muscular structures. Importantly, urothelial carcinoma has a high rate of recurrence despite periodic surveillance using standard MR imaging and CT imaging, which impacts the management of the disease.
There has been an increasing role in the use of FDG-PET/CT imaging in the diagnosis of primary and recurrent urothelial carcinoma, which can play a role in restaging to assess the extent of disease/disease burden and management decisions. FDG-PET/CT imaging has been shown to have improved detection of recurrent disease post-treatment compared to standard CT imaging alone.
Methods: To provide imaging characteristics of urinary tract tumors to understand their pathophysiology with an emphasis on the impact of 18F-FDG PET/CT (PET/CT) findings in their clinical management at various stages of the disease. To provide imaging characteristics and clinical information of mimics of urinary tract tumors that can be visualized on PET/CT imaging and pearls to provide an accurate diagnosis. Help to familiarize radiologists with the use of PET/CT imaging in the evaluation, diagnosis, and staging of GU cancers or metastatic disease within this region.
Results: 18F-FDG PET imaging with CT has a vital role in the identification of primary urothelial carcinomas, determining the presence and extent of disease as well as providing information helpful in identifying mimics of urothelial cancer as well as metastases within the urinary tract. Urothelial carcinoma (UC) recurs in more than 50% of patients. 18F-FDG PET imaging with CT correlation is highly reliable and can more accurately identify recurrence in patients with urothelial cancers compared to standard CT imaging.
Conclusions: It is important to correlate CT imaging with 18F-FDG PET as it helps account for any false high-level activity due to increased excretion of FDG within the urinary tract, as opposed to true disease. PET/CT can play a key role in patients’ management by providing information about tumor burden and locations for the selection of treatment plans by Oncology and Radiation Oncology. It also provides the information needed to deliver the patient a realistic prognosis.