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Pathak P, Abandeh L, Aboughalia H, Pooyan A, Mansoori B. Overview of F18-FDG uptake patterns in retroperitoneal pathologies: imaging findings, pitfalls, and artifacts. Abdom Radiol (NY) 2024; 49:1677-1698. [PMID: 38652126 DOI: 10.1007/s00261-023-04139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Retroperitoneum can be the origin of a wide variety of pathologic conditions and potential space for disease spread to other compartments of the abdomen and pelvis. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the initial imaging modalities to evaluate the retroperitoneal pathologies, however given the intrinsic limitations, F18-FDG PET/CT provides additional valuable metabolic information which can change the patient management and clinical outcomes. We highlight the features of retroperitoneal pathologies on F18-FDG PET/CT and the commonly encountered imaging artifacts and pitfalls. The aim of this review is to characterize primary and secondary retroperitoneal pathologies based on their metabolic features, and correlate PET findings with anatomic imaging. CONCLUSION Retroperitoneal pathologies can be complex, ranging from oncologic to a spectrum of non-oncologic disorders. While crosse-sectional imaging (CT and MRI) are often the initial imaging modalities to localize and characterize pathologies, metabolic information provided by F18-FDG PET/CT can change the management and clinical outcome in many cases.
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Affiliation(s)
- Priya Pathak
- Abdominal Imaging and Nuclear Medicine Divisions, Department of Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Laith Abandeh
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Hassan Aboughalia
- Department of Radiology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Atefe Pooyan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Bahar Mansoori
- Abdominal Imaging Division, Department of Radiology, University of Washington, Seattle, WA, USA
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2
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Zhang J, Dong A, Wang Y. FDG PET/CT in Solitary Isolated Renal Metastasis From Squamous Cell Lung Cancer. Clin Nucl Med 2024; 49:e50-e51. [PMID: 38048520 DOI: 10.1097/rlu.0000000000004983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
ABSTRACT We describe FDG PET/CT findings in a patient with a solitary isolated renal metastasis from squamous cell lung cancer. The renal metastasis appeared as a small focus of activity at the renal cortex on FDG PET/CT at initial staging of the lung tumor, misinterpreted as cortical tracer retention, and was significantly enlarged on the second FDG PET/CT performed 4 months after the first PET/CT. This case demonstrates the usefulness of FDG PET/CT in identifying unexpected extrathoracic metastasis from lung cancer. Focal FDG uptake in the renal cortical region in a cancer patient should be evaluated carefully to avoid misdiagnosis.
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Affiliation(s)
- Jun Zhang
- From the Department of Cardiothoracic Surgery, The Second Affiliated Hospital, Jiaxing University, Jiaxing
| | - Aisheng Dong
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University
| | - Yang Wang
- Department of Pathology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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Sri Charan KB, Kalawat T, Priya RR, Nallabothula AK, Manthri RG, Reddy SC, Narendra H, Rukmangadha N, Kale PKG, Ajit N. Utility of Fluorine18 Fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computed Tomography in Metabolic Characterization of Solid Renal Mass Lesion and Localization of Extra Renal Lesions in the Body - A Prospective Study from the Tertiary Care Center in South India. Indian J Nucl Med 2022; 37:329-336. [PMID: 36817204 PMCID: PMC9930448 DOI: 10.4103/ijnm.ijnm_41_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 02/26/2022] [Accepted: 05/19/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose of the Study Renal mass lesions in majority of the cases are due to malignant etiology and about one-third of them are reported with metastatic lesions at the time of presentation. Thus proper investigational workup is needed for staging and thereby treatment planning. The current fluorine18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F18-FDG PET/CT) study was designed to characterize renal mass lesions metabolically and identifying other metabolically active lesions in the body suggesting metastatic disease. Materials and Methods A total of 24 patients (males - 18 and females - 6) with a mean age of 53.8 ± 12.3 years were recruited in this study for dual time-point PET/CT scan. All patients with renal mass lesions underwent contrast-enhanced CT prior to PET/CT. Metabolic parameters such as maximum standardized uptake value (max.SUV) with a cut off ≥2.5 and retention index (RI) of ≥10% were used to label the lesion as malignant and remaining less than cutoff as benign. The final diagnosis of lesion on imaging was confirmed with a histopathological examination (HPE). Results Using max.SUV cut off value, 17/24 renal mass lesions were characterized as malignant and remaining 7/24 renal lesions of benign etiology. PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 80%, 75%, 94.1%, 42.8%, and 79.1%, respectively, by considering HPE as a gold standard. Nine patients were diagnosed with distant site involvement suggestive of metastases. Conclusion F18-FDG PET/CT can efficiently characterize solid renal mass lesion as benign and malignant using metabolic parameters such as max.SUV and RI. In addition, whole-body survey identified distant site involvement in 25% of the patients, thus contributing change in management.
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Affiliation(s)
| | - Tekchand Kalawat
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Rallapeta Ramya Priya
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Anil Kumar Nallabothula
- Department of Urology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Ranadheer Gupta Manthri
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | | | - Hulikal Narendra
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Nandyala Rukmangadha
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Pavan Kumar G Kale
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Nimmagadda Ajit
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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FDG PET/CT in Unilateral Renal Metastasis From Colon Cancer. Clin Nucl Med 2022; 47:1000-1002. [PMID: 35867982 DOI: 10.1097/rlu.0000000000004326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Renal metastasis from colon cancer is rare. We describe FDG PET/CT findings in a case with a right renal and a postcaval lymph node metastasis from colon cancer. Both the renal tumor and postcaval lymph node showed increased FDG uptake with SUVmax of 6.1 for the renal tumor and 5.5 for the postcaval lymph node. The imaging findings mimicked a primary renal cancer with postcaval lymph node metastasis.
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Rennert J, Grosse J, Einspieler I, Bäumler W, Stroszczynski C, Jung EM. Complementary imaging of ultrasound and PET/CT: A new opportunity? Clin Hemorheol Microcirc 2021; 79:39-54. [PMID: 34420945 DOI: 10.3233/ch-219105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM To evaluate the effectiveness of complementary imaging of high-resolution ultrasound including CEUS with PET/CT for tissue characterization and tumor detection. MATERIAL AND METHODS 100 patients were examined with PET/CT and US/CEUS between January 2018 until February 2020. All patients underwent PET/CT followed by selective US/CEUS within 4 weeks. Comparison regarding concordant or diverging findings in PET/CT and US. Analysis of the differences concerning the lesions number of found by PET/CT and US/CEUS or the possibility of a secured diagnosis following ultrasound causing therapeutic changes. RESULTS Diverging findings regarding the number of liver lesions in PET/CT and CEUS were found in 35 out of 64 patients (54%). Regarding renal lesions, a more definite diagnosis following ultrasound, causing a change of therapeutic approach, was achieved in 89%. Concordant results in PET/CT and US were found in 83% of patients with splenic and nodal findings. In 78% of patients with increased musculoskeletal or soft tissue tracer uptake, US was able to make a secured diagnosis with therapeutic changes. CONCLUSION The present results indicate a strong benefit of complementary imaging of PET/CT and selective, high-resolution ultrasound especially in patients with liver, renal and musculoskeletal or soft tissue findings.
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Affiliation(s)
- Janine Rennert
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Jirka Grosse
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Ingo Einspieler
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Wolf Bäumler
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Hanssen O, Lovinfosse P, Weekers L, Hustinx R, Jouret F. [ 18F-FDG positron emission tomography in non-oncological renal pathology: Current indications and perspectives]. Nephrol Ther 2019; 15:430-438. [PMID: 30982747 DOI: 10.1016/j.nephro.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/28/2018] [Indexed: 12/26/2022]
Abstract
Positron emission tomography combined with computed tomography (PET/CT) is a nuclear imaging technique which provides anatomical and functional information. PET/CT is increasingly used in non-oncological nephrology since conventional radiological approaches after injection of contrast agents are relatively contra-indicated in patients with chronic kidney disease (CKD). PET/CT after i.v. injection of 18F-fluoro-deoxy-glucose (FDG) is not toxic and is characterized by a high sensitivity. The level of irradiation (∼5mSv) is acceptable. CKD does not significantly influence tissue uptake of 18F-FDG. The purpose of the present review aims at detailing the non-oncological indications of 18F-FDG PET/CT in general nephrology and after kidney transplantation. Particularly, 18F-FDG PET/CT appears useful in the diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease, as well as in the characterization of retroperitoneal fibrosis. In kidney transplant recipients, 18F-FDG PET/CT may help in the diagnostic work-up of suspected acute rejection, thereby eventually avoiding unnecessary kidney transplant biopsy. Perspectives in 18F-FDG PET/CT imaging are discussed, including innovative approaches of image analysis.
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Affiliation(s)
- Oriane Hanssen
- Service de néphrologie, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - Pierre Lovinfosse
- Service de médecine nucléaire et imagerie oncologique, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - Laurent Weekers
- Service de médecine nucléaire et imagerie oncologique, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - Roland Hustinx
- Service de médecine nucléaire et imagerie oncologique, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - François Jouret
- Service de néphrologie, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique; Groupe interdisciplinaire de géno-protéomique appliquée (GIGA), sciences cardiovasculaires, université de Liège, Liège, Belgique.
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18F-FDG PET/CT Demonstrates Renal Cell Cancer in a Transplant With Synchronous Intestinal Infection. Clin Nucl Med 2019; 44:e294-e295. [DOI: 10.1097/rlu.0000000000002482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Chappell JC, Payne LB, Rathmell WK. Hypoxia, angiogenesis, and metabolism in the hereditary kidney cancers. J Clin Invest 2019; 129:442-451. [PMID: 30614813 DOI: 10.1172/jci120855] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The field of hereditary kidney cancer has begun to mature following the identification of several germline syndromes that define genetic and molecular features of this cancer. Molecular defects within these hereditary syndromes demonstrate consistent deficits in angiogenesis and metabolic signaling, largely driven by altered hypoxia signaling. The classical mutation, loss of function of the von Hippel-Lindau (VHL) tumor suppressor, provides a human pathogenesis model for critical aspects of pseudohypoxia. These features are mimicked in a less common hereditary renal tumor syndrome, known as hereditary leiomyomatosis and renal cell carcinoma. Here, we review renal tumor angiogenesis and metabolism from a HIF-centric perspective, considering alterations in the hypoxic landscape, and molecular deviations resulting from high levels of HIF family members. Mutations underlying HIF deregulation drive multifactorial aberrations in angiogenic signals and metabolism. The mechanisms by which these defects drive tumor growth are still emerging. However, the distinctive patterns of angiogenesis and glycolysis-/glutamine-dependent bioenergetics provide insight into the cellular environment of these cancers. The result is a scenario permissive for aggressive tumorigenesis especially within the proximal renal tubule. These features of tumorigenesis have been highly actionable in kidney cancer treatments, and will likely continue as central tenets of kidney cancer therapeutics.
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Affiliation(s)
- John C Chappell
- Center for Heart and Regenerative Medicine, Departments of Biomedical Sciences and Biomedical Engineering and Mechanics, Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Laura Beth Payne
- Center for Heart and Regenerative Medicine, Departments of Biomedical Sciences and Biomedical Engineering and Mechanics, Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - W Kimryn Rathmell
- Vanderbilt-Ingram Cancer Center, Departments of Medicine and Biochemistry, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Pencharz D, Nathan M, Wagner TL. Evidence-based management of incidental focal uptake of fluorodeoxyglucose on PET-CT. Br J Radiol 2018; 91:20170774. [PMID: 29243502 DOI: 10.1259/bjr.20170774] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Focal incidental uptake, with or without CT abnormalities, is a common finding on fluorodeoxyglucose PET/CT and evidence-based management for this type of uptake is lacking. This article reviews the evidence on focal incidental uptake including the incidence of malignancy, differential diagnosis and imaging criteria which can be used to further characterize it. The article focusses on PET rather than CT criteria. The strength of the evidence base is highly variable ranging from systematic reviews and meta-analyses to a virtual absence of evidence. Caution needs to be used when using standardized uptake values (SUVs) reported in other studies due to interpatient and institution observed variation in SUVs. There is sufficient evidence to permit specific suggestions on how to interpret the foci and recommend further management in the: pituitary (investigate when SUVmax >4.1), thyroid (investigate all), breast (investigate all), lung parenchyma (if focus of fluorodeoxyglucose without a CT nodule, no further investigations), colon (investigate all foci with SUVmax >5.9, urgently if SUVmax >11.4), adrenals (criteria depend on if patient has cancer) and prostate gland (investigate in males aged >50 years or >40 years if peripheral uptake or patient has other risk factors). There is some evidence to guide further management for the parotid gland, naso-orophaynx, oesophagus, pancreas, uterus and ovaries. There is insufficient evidence to guide management for the liver, spleen, kidneys, gallbladder, testis and bone, for these organs patient characteristics and other guidelines will likely be of more use in determining further management.
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Affiliation(s)
- Deborah Pencharz
- 1 Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust , Brighton, East Sussex , UK
| | - Malavika Nathan
- 2 Department of Nuclear Medicine, Royal Free Hospital NHS Foundation Trust , London , UK
| | - Thomas L Wagner
- 2 Department of Nuclear Medicine, Royal Free Hospital NHS Foundation Trust , London , UK
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Clinical utility of FDG PET/CT in acute complicated pyelonephritis-results from an observational study. Eur J Nucl Med Mol Imaging 2017; 45:462-470. [PMID: 28951990 DOI: 10.1007/s00259-017-3835-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acute complicated pyelonephritis (ACP) is an upper urinary tract infection associated with coexisting urinary tract abnormalities or medical conditions that could predispose to serious outcomes or treatment failures. Although CT and magnetic resonance imaging (MRI) are frequently used in patients with ACP, the clinical value of 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) has not been systematically investigated. This single-center retrospective study was designed to evaluate the potential usefulness of FDG PET/CT in patients with ACP. METHODS Thirty-one adult patients with ACP who underwent FDG PET/CT were examined. FDG PET/CT imaging characteristics, including tracer uptake patterns, kidney volumes, and extrarenal imaging findings, were reviewed in combination with clinical data and conventional imaging results. RESULTS Of the 31 patients, 19 (61%) showed focal FDG uptake. The remaining 12 study participants showed a diffuse FDG uptake pattern. After volumetric approximation, the affected kidneys were found to be significantly enlarged. Patients who showed a focal uptake pattern had a higher frequency of abscess formation requiring drainage. ACP patients showing diffuse tracer uptake patterns had a more benign clinical course. Seven patients had suspected extrarenal coinfections, and FDG PET/CT successfully confirmed the clinical suspicion in five cases. FDG PET/CT was as sensitive as CT in identifying the six patients (19%) who developed abscesses. Notably, FDG PET/CT findings caused a modification to the initial antibiotic regimen in nine patients (29%). CONCLUSIONS FDG PET/CT may be clinically useful in the assessment of patients with ACP who have a progressive disease course.
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Abstract
Clinically, renal metastasis from esophageal squamous cell carcinoma is uncommon. We present 2 cases of renal metastasis from esophageal squamous cell carcinoma with enhanced CT and FDG PET/CT findings. In the first case, right kidney and right renal hilum were the only known metastatic sites. In the second case, bilateral kidneys were the only known metastatic sites. All the renal metastatic tumors appeared as hypovascular and hypoattenuating masses involving both the renal cortex and medulla on enhanced CT and intense FDG uptake on FDG PET/CT.
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12
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Smith CJ, Wang MX, Feely M, Otto B, Grajo JR. Oncocytoma: A Differential Consideration for an Incidentally Detected FDG-Avid Renal Mass on PET/CT. J Radiol Case Rep 2017; 11:27-33. [PMID: 29299091 DOI: 10.3941/jrcr.v11i5.3117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Renal oncocytoma is a benign renal neoplasm that is often discovered incidentally and closely mimics renal cell carcinoma on common imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). Due to the inability to reliably distinguish between these benign and malignant lesions with imaging, both are typically treated as if they are malignant. Hypermetabolic activity of renal oncocytomas is not frequently encountered because positron emission tomography (PET) is not a standard modality for imaging primary renal tumors. We present a case of a 65 year-old female with a history of thyroid cancer who had an incidentally discovered hypermetabolic renal mass on surveillance PET-CT imaging. Due to the concern for a primary renal malignancy or metastatic disease, the mass was resected and proven to be an oncocytoma on pathologic review.
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Affiliation(s)
| | - Mindy X Wang
- Department of Radiology, UF Health Shands Hospital, Gainesville, FL, USA
| | - Michael Feely
- Department of Pathology, UF Health Shands Hospital, Gainesville, FL, USA
| | - Brandon Otto
- Department of Urology, UF Health Shands Hospital, Gainesville, FL, USA
| | - Joseph R Grajo
- Department of Radiology, UF Health Shands Hospital, Gainesville, FL, USA
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Karaosmanoglu AD, Onur MR, Tabari A, Karcaaltincaba M, Arellano RS. Role of multimodality imaging in the diagnosis of lymphoproliferative malignancies and hematologic disorders of the kidneys. Abdom Radiol (NY) 2017; 42:242-253. [PMID: 27535385 DOI: 10.1007/s00261-016-0873-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lymphoproliferative and hematologic disorders of the kidney may present with focal or diffuse renal parenchymal involvement in clinical practice. Radiologic findings of lymphoproliferative and hematologic disorders of the kidney may mimick primary neoplastic and inflammatory disorders of the kidney. All cross-sectional imaging modalities including ultrasonography, computed tomography, and magnetic resonance imaging may be used in the diagnosis of these diseases. Percutaneous biopsy may be used in problematic cases for definitive diagnosis.
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Affiliation(s)
- Ali Devrim Karaosmanoglu
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe Universitesi Tıp Fakültesi Hastanesi, Sıhhiye, 06100, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
- Hacettepe Universitesi Tıp Fakültesi Hastanesi, Sıhhiye, 06100, Ankara, Turkey.
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White 270, Boston, MA, 02114, USA
| | - Musturay Karcaaltincaba
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe Universitesi Tıp Fakültesi Hastanesi, Sıhhiye, 06100, Ankara, Turkey
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White 270, Boston, MA, 02114, USA
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Fat-Containing Hypermetabolic Masses on FDG PET/CT: A Spectrum of Benign and Malignant Conditions. AJR Am J Roentgenol 2016; 207:1095-1104. [PMID: 27490138 DOI: 10.2214/ajr.16.16066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This article focuses on identifying the imaging appearances of hypermetabolic fatty masses and masslike lesions on PET/CT and understanding the diagnostic challenges radiologists may face while interpreting findings of these lesions on PET/CT. This article provides an approach to aid in the diagnosis of these lesions and the appropriate management of patients. CONCLUSION Both malignant and benign fat-containing masses and masslike lesions can show hypermetabolic activity on PET/CT. Although the differential diagnosis is broad, clinical history, anatomic location, and knowledge of anatomic variants and imaging features can help radiologists avoid misinterpretation of benign fatty lesions as malignancy.
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Capitanio U, Leibovich BC. The rationale and the role of lymph node dissection in renal cell carcinoma. World J Urol 2016; 35:497-506. [DOI: 10.1007/s00345-016-1886-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/23/2016] [Indexed: 01/29/2023] Open
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Abstract
Renal cell carcinoma has a variable uptake of F-FDG resulting in poor sensitivity and limited clinical application. There is intense interest in improved molecular imaging of this condition. We present a case of a 64-year-old man with known metastatic renal cell carcinoma found to have intense uptake of Rb but not F-FDG in multiple thoracic metastases seen on imaging performed to assess myocardial hibernation.
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Angiomyolipoma being surgically excised for presumed kidney carcinoma. Int Urol Nephrol 2015; 47:1037-43. [PMID: 25940032 DOI: 10.1007/s11255-015-0996-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the important factors involved in angiomyolipoma (AML) being preoperatively misclassified and surgically removed for presumed kidney carcinoma. MATERIALS AND METHODS From 2008 to 2014, AML was pathologically confirmed in 38 patients who underwent radical or partial nephrectomy for presumed malignant renal tumor. Control group 1 were patients with renal cell carcinoma (RCC) matched for age and tumor size; control group 2 were patients with typical AML matched for age and sex. Pertinent data of the studied group and its matched control groups were recorded and analyzed. RESULTS The mean age of the patients in study group was 48.11 ± 12.92 years, and the mean tumor size was 3.12 ± 1.68 cm (range 0.9-9.4). More than 84 % of the misclassified AMLs measured ≤4 cm, and over 21 % patients underwent radical nephrectomy. The only statistically significant feature between the misdiagnosed AML group and the matched RCC group is mean age (48.11 ± 12.92 vs. 56.92 ± 10.28, P = 0.002). Compared with the matched typical AML group, the misdiagnosed AML group has smaller mean tumor size (3.12 ± 1.68 vs. 5.85 ± 3.33, P < 0.001), but more patients undergoing radical nephrectomy (21.05 vs. 0 %, P = 0.003). Two main imaging features, which are hypoechoic on ultrasonography and fat density on computed tomography (CT), were statistically different between the two groups. The misdiagnosis of AML was significantly associated with no fat density on CT (OR 5.528, P = 0.004) and hypoechoic on ultrasonography (OR 3.845, P = 0.017). CONCLUSIONS A number of AMLs were misdiagnosed as RCCs, causing a large number of unnecessary surgeries. No fat density on CT and no hyperechoic on ultrasonography resulting from small tumor size were the two most important factors causing AML being excised for presumed kidney carcinoma. Ultrasonography and CT cannot differentiate atypical AML from kidney carcinoma effectively, so improved renal biopsy and noninvasive biomarkers are urgently warranted to prevent us from excising benign renal tumor aggressively.
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Win AZ, Aparici CM. Clinical effectiveness of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography in management of renal cell carcinoma: a single institution experience. World J Nucl Med 2015; 14:36-40. [PMID: 25709543 PMCID: PMC4337006 DOI: 10.4103/1450-1147.150535] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Positron emission tomography (PET) is currently the most advanced technique of metabolic imaging available for tumor diagnosis and follow-up. The aim of this study was to examine the versatility and accuracy of fluorodeoxyglucose (FDG) PET/computed tomography (CT) in the metastasis detection of renal cell carcinoma (RCC). We also compared our findings to other similar studies from the literature. This is the biggest study so far to examine the sensitivity and specificity of FDG PET/CT in the management of RCC. A retrospective review was carried out on all the FDG PET/CT studies done from January 1999 to January 2014 at our institution. Biopsy results were considered the gold standard. For our patients (n = 315) with biopsy results, FDG PET/CT studies exhibited 100% sensitivity, 100% specificity. Our results were better than results achieved by other studies. The use of FDG PET/CT in restaging and metastasis detection of RCC has many advantages, in addition to high accuracy. This imaging technique has great potential in influencing treatment decisions. We recommend the incorporation of FDG PET/CT in routine standard protocols for RCC.
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Affiliation(s)
- Aung Zaw Win
- Department of Radiology, San Francisco VA Medical Center, San Francisco, CA 94121, USA
| | - Carina Mari Aparici
- Department of Radiology, San Francisco VA Medical Center, San Francisco, CA 94121, USA ; Department of Radiology, University California San Francisco, San Francisco, CA 94143, USA
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Abstract
A matter of months after Roentgen's landmark discovery in 1895, Roentgen's rays were focused on diseases and disorders of the urinary tract, specifically the kidney. At the dawn of the 20th century, urologists in the United States and around the world quickly recognized that by using a variety of metal stylets and radiopaque contrast agents, such as silver salts, the upper urinary tract, namely the ureter, pelvis, and calyces, could be depicted with radiography. Renal cysts and tumors were diagnosed on the basis of deformities in the kidney. Retrograde pyelography dominated the imaging evaluation of the kidney until the discovery of a safe intravenous method for urinary tract imaging (ie, intravenous pyelography). Pioneers and pathfinders in the field of contrast media development and radiologic procedures helped give radiologists the lead role in the work-up of renal masses, an area where urologists once held forth. The subspecialty of uroradiology was born in the middle of the 20th century. Intravenous urography, nephrotomography, and diagnostic angiography with pharmacologic manipulation followed by cyst or mass puncture and biopsy yielded unrivaled specificity for the diagnosis and staging of benign and malignant renal masses. The advent of cross-sectional and multiplanar imaging and the profound effects they had and continue to have on the discovery and characterization of renal masses has been detailed in the pages of Radiology since the 1920s. Ultrasonography, nuclear imaging, computed tomographic scanning, magnetic resonance imaging, and positron emission tomography each have made a claim to a part of the imaging algorithm of modern uroradiologic practice.
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Affiliation(s)
- Bruce L McClennan
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510
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Sato N, Nakamura Y, Takanami K, Ono Y, Omata K, Morimoto R, Satoh F, Ise K, Yamada S, Kasajima A, Fujishima F, Watanabe M, Arai Y, Sasano H. Case report: adrenal oncocytoma associated with markedly increased FDG uptake and immunohistochemically positive for GLUT1. Endocr Pathol 2014; 25:410-5. [PMID: 25284122 DOI: 10.1007/s12022-014-9337-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Usually, benign tumors are not associated with an increased F-18 fluorodeoxyglucose (F-18 FDG) uptake on positron emission tomography (PET), although some exceptions have been reported in adrenal neoplasms. We present a rare case of adrenocortical oncocytoma associated with markedly increased FDG uptake, demonstrating a maximum standardized uptake value of 46.8. Histological examination demonstrated diffuse proliferation of tumor cells with eosinophilic and granular cytoplasm that were diffusely immunopositive for mitochondria and glucose transport protein 1, with focal and weak immunopositivity for 3β-hydroxysteroid dehydrogenase. Ultrastructural examination also revealed abundant mitochondria in the tumor cells. The tumor was diagnosed as adrenocortical oncocytoma and was considered benign according to Lin-Weiss-Bisceglia criteria. Diagnosis of adrenocortical oncocytoma can pose difficulties during both preoperative radiological and postoperative histopathological investigations.
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Affiliation(s)
- Naomi Sato
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
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21
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Nanni C, Zanoni L, Fanti S. Nuclear medicine in urological cancers: what is new? Future Oncol 2014; 10:2061-72. [DOI: 10.2217/fon.14.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT The diffusion of PET/computed tomography has opened up a new role for nuclear imaging in urological oncology. Prostate cancer is evaluated with choline (11C or 18F) PET due to a lack of sensitivity of 18F-fluorodeoxyglucose (FDG). However, many new tracers, such as 18F-fluorocyclobutane-1-carboxylic acid and 68Ga-prostate-specific membrane antigen, are under investigation, offering promising results in the particular setting of radically treated patients with biochemical relapse. The performance of 18F-FDG depends on the histological type; indeed, renal cell cancer may present variable metabolic uptake. In this field, mainly antibodies labeled with positron emitters are under clinical evaluation. Finally, 18F-FDG PET/computed tomography has been proven to show good accuracy in detecting metastatic testicular and bladder cancers, despite not having valid results in detecting local disease. The urological cancer diagnostic process is currently under continuous development.
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Affiliation(s)
- Cristina Nanni
- OU Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Via Massarenti, 9-40138 Bologna, Italy
| | - Lucia Zanoni
- OU Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Via Massarenti, 9-40138 Bologna, Italy
| | - Stefano Fanti
- OU Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Via Massarenti, 9-40138 Bologna, Italy
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Aparici CM, Win AZ. Use of NaF-18-Positron Emission Tomography/Computed Tomography in the Detection of Bone Metastasis from Papillary Renal Cell Carcinoma. World J Nucl Med 2014; 13:135-7. [PMID: 25191130 PMCID: PMC4150157 DOI: 10.4103/1450-1147.139146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 60-year-old white male with a history of papillary renal cell carcinoma (PRCC) status postpartial nepherectomy. He was followed-up annually with abdominal computed tomography (CT) scans to monitor for tumor recurrence. A solitary metastatic bony lesion was detected by CT 4 years after partial nephrectomy and it was confirmed by NaF-positron emission tomography (PET)/CT and magnetic resonance imaging. He underwent external beam radiation therapy (XRT) for solitary metastasis to L1 vertebra. The L1 lesion was treated with XRT, which exhibited no fluorodeoxyglucose activity after the treatment. This is the first case report to mention the use of NaF-18-PET/CT in the detection of bone metastasis from PRCC. Our case once again emphasizes the usefulness of NaF-18-PET/CT in RCC follow-up.
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Affiliation(s)
- Carina Mari Aparici
- Department Radiology, Nuclear Medicine Section, UCSF, San Francisco, CA, USA
| | - Aung Zaw Win
- Department Radiology, San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA
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Ellimoottil C, Greco KA, Hart S, Patel T, Sheikh MM, Turk TMT, Flanigan RC. New modalities for evaluation and surveillance of complex renal cysts. J Urol 2014; 192:1604-11. [PMID: 25072181 DOI: 10.1016/j.juro.2014.07.099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE The increased use of abdominal imaging has led to more frequent detection of incidental renal cysts. Since the inception of the Bosniak classification system, management of Bosniak I, III and IV cysts has been clearly defined, while evaluation and management of Bosniak II and IIF cysts have remained a clinical dilemma. Discussions of new imaging modalities are becoming increasingly prevalent in the radiological literature. In this context we performed a comprehensive review of the recent literature on complex renal cysts focusing on new imaging modalities, surveillance strategies and biopsy. MATERIALS AND METHODS We performed a comprehensive literature review of articles published from January 1, 1998 through December 31, 2013 via MEDLINE(®), EMBASE and the Cochrane Collection using a predetermined search strategy. All studies included were performed in humans older than 18 years, were written in English and had an abstract available for review. We grouped studies into 1 of 5 categories, ie computerized tomography, magnetic resonance imaging, ultrasound, biopsy and surveillance. RESULTS While computerized tomography and magnetic resonance imaging with and without contrast enhancement remain the gold standard to evaluate cystic lesions of the kidney, diffusion-weighted magnetic resonance imaging and contrast enhanced ultrasound have surfaced as new tools for assessment of complex cysts. Comparative effectiveness studies on these new imaging modalities are limited. Image guided biopsy has increasingly been shown to be useful for evaluation of intermediate (Bosniak II and IIF) complex cysts. We found few studies providing guidance on the duration and/or intensity of surveillance required for intermediate complex renal cysts. CONCLUSIONS Although new and enhanced techniques are in development and may be useful in the future management of complex renal cysts, there is a paucity of data regarding the value of these new techniques. Future research should focus on surveillance of intermediate complex renal cysts, particularly on the ideal frequency and type of imaging required.
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Affiliation(s)
- Chandy Ellimoottil
- Department of Urology, Loyola University Medical Center, Maywood, Illinois.
| | - Kristin A Greco
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Spencer Hart
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Tejas Patel
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - M Mukarram Sheikh
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Thomas M T Turk
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Robert C Flanigan
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
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Malignant renal epithelioid angiomyolipoma with liver metastasis after resection: a case report with multimodality imaging and review of the literature. J Comput Assist Tomogr 2014; 38:574-7. [PMID: 24887578 DOI: 10.1097/rct.0000000000000101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Renal epithelioid angiomyolipoma (EAML) is a perivascular epithelioid cell tumor. Although the overwhelming majority of renal EAMLs are benign, cases of aggressive behavior and malignancy have been reported. Here, we report the case of a 62-year-old woman with a 12.5-cm renal EAML, who underwent resection and developed a 10.5-cm hepatic EAML 15 months after the surgery. Although multicentric disease is a possibility, the temporal course is consistent with metastasis from the poorly differentiated primary tumor. This is the only report with multimodality imaging to detail new metastatic disease during surveillance after intended curative resection of an EAML.
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Granda ML, Schroeder FA, Borra RHJ, Schauer N, Aisaborhale E, Guimaraes AR, Hooker JM. First D1-like receptor PET imaging of the rat and primate kidney: implications for human disease monitoring. Am J Physiol Renal Physiol 2014; 307:F116-21. [PMID: 24808534 DOI: 10.1152/ajprenal.00111.2014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The intrarenal dopamine system is important for signaling and natriuresis, and significant dysfunction is associated with hypertension and kidney disease in ex vivo studies. Dopamine receptors also modulate and are modulated by the renin-angiotensin-aldosterone system. Here, we show the first in vivo measurement of D1-like receptors in the renal cortex of Sprague-Dawley rat and Papio anubis baboon using [(11)C]NNC 112, a positron emission tomography radioligand for D1-like receptors. In addition, we show a D1-like binding potential response to angiotensin II blockade in rats using losartan. Demonstration of self-saturable binding in the rat as well as specific and saturable binding in Papio anubis validate the use of [(11)C]NNC 112 in the first in vivo measurement of renal dopamine D1-like receptors. Furthermore, [(11)C]NNC 112 is a radioligand tool already validated for use in probing human central nervous system (CNS) D1-like receptors. Our work demonstrates specific and saturable non-CNS binding in higher animals and the ability to quantify physiological response to drug treatment and provides a clear path to extend use of [(11)C]NNC 112 to study renal dopamine in humans.
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Affiliation(s)
- Michael L Granda
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; and Eastern Virginia Medical School, Norfolk, Virginia
| | - Frederick A Schroeder
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; and
| | - Ronald H J Borra
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; and
| | - Nathan Schauer
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; and
| | - Ehimen Aisaborhale
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; and
| | - Alexander R Guimaraes
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; and
| | - Jacob M Hooker
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; and
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Abstract
There is an expanding and exciting repertoire of PET imaging radiotracers for urogenital diseases, particularly in prostate cancer, renal cell cancer, and renal function. Prostate cancer is the most commonly diagnosed cancer in men. With growing therapeutic options for the treatment of metastatic and advanced prostate cancer, improved functional imaging of prostate cancer beyond the limitations of conventional CT and bone scan is becoming increasingly important for both clinical management and drug development. PET radiotracers, apart from ¹⁸F-FDG, for prostate cancer are ¹⁸F-sodium fluoride, ¹¹C-choline, and ¹⁸F-fluorocholine, and (¹¹C-acetate. Other emerging and promising PET radiotracers include a synthetic l-leucine amino acid analogue (anti-¹⁸F-fluorocyclobutane-1-carboxylic acid), dihydrotestosterone analogue (¹⁸F-fluoro-5α-dihydrotestosterone), and prostate-specific membrane antigen-based PET radiotracers (eg, N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]-4-¹⁸F-fluorobenzyl-l-cysteine, ⁸⁹Zr-DFO-J591, and ⁶⁸Ga [HBED-CC]). Larger prospective and comparison trials of these PET radiotracers are needed to establish the role of PET/CT in prostate cancer. Although renal cell cancer imaging with FDG-PET/CT is available, it can be limited, especially for detection of the primary tumor. Improved renal cell cancer detection with carbonic anhydrase IX (CAIX)-based antibody (¹²⁴I-girentuximab) and radioimmunotherapy targeting with ¹⁷⁷Lu-cG250 appear promising. Evaluation of renal injury by imaging renal perfusion and function with novel PET radiotracers include p-¹⁸F-fluorohippurate, hippurate m-cyano-p-¹⁸F-fluorohippurate, and rubidium-82 chloride (typically used for myocardial perfusion imaging). Renal receptor imaging of the renal renin-angiotensin system with a variety of selective PET radioligands is also becoming available for clinical translation.
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Affiliation(s)
- Steve Y Cho
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Zsolt Szabo
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD.
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Kumar S, Choudhary GR, Nanjappa B, Bal A. Benign medullary fibroma of the kidney: a rare diagnostic dilemma. J Clin Imaging Sci 2013; 3:43. [PMID: 24228211 PMCID: PMC3823390 DOI: 10.4103/2156-7514.120776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 09/06/2013] [Indexed: 11/11/2022] Open
Abstract
Renomedullary interstitial cell tumor or medullary fibroma, is a small tumor that commonly presents as an incidental finding, but in rare cases maybe large and symptomatic. Although it is a benign tumor, it is difficult to differentiate this lesion from other malignancies of the kidney on radiological basis and hence many patients undergo radical nephrectomy. We present a case of renal medullary fibroma and various nuances associated with radiological identification of this lesion and its management related dilemmas.
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Affiliation(s)
- Santosh Kumar
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Malignant epithelioid angiomyolipoma: tumor and metabolic response to everolimus as evaluated with positron emission tomography. Clin Genitourin Cancer 2013; 11:e1-5. [PMID: 23791549 DOI: 10.1016/j.clgc.2013.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 12/17/2022]
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Lin CY, Chen HY, Ding HJ, Yen KY, Kao CH. FDG PET or PET/CT in evaluation of renal angiomyolipoma. Korean J Radiol 2013; 14:337-42. [PMID: 23483018 PMCID: PMC3590350 DOI: 10.3348/kjr.2013.14.2.337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/31/2012] [Indexed: 11/15/2022] Open
Abstract
Objective Angiomyolipoma is the most common benign kidney tumor. However, literature describing FDG PET findings on renal angiomyolipoma (AML) is limited. This study reports the FDG PET and PET/CT findings of 21 cases of renal AML. Materials and Methods The study reviews FDG PET and PET/CT images of 21 patients diagnosed with renal AML. The diagnosis is based on the classical appearance of an AML on CT scan with active surveillance for 6 months. The study is focused on the observation of clinical and radiographic features. Results Six men and 15 women were included in our study. The mean age of the patients was 57.14 ± 9.67 years old. The mean diameter of 21 renal AML on CT scans was 1.76 ± 1.00 cm (Min: 0.6 cm; Max: 4.4 cm). CT scans illustrated renal masses typical of AMLs, and the corresponding FDG PET scans showed minimal FDG activities in the area of the tumors. None of the 21 AMLs showed a maximum standardized uptake value (SUVmax) greater than 1.98. No statistically significant correlation was present between SUVmax and tumor size. Conclusion Renal AMLs demonstrate very low to low uptake on FDG PET and PET/CT imaging in this study. When a fat-containing tumor in the kidney is found on a CT scan, it is critical to differentiate an AML from a malignant tumor including an RCC, liposarcoma, and Wilms tumor. This study suggests that FDG PET or PET/CT imaging is useful for differentiating a renal AML from a fat-containing malignant tumor.
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Affiliation(s)
- Chun-Yi Lin
- Department of Nuclear Medicine, Show Chwan Memorial Hospital, Changhua 500, Taiwan
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PET/CT and Renal Pathology: A Blind Spot for Radiologists? Part 2—Lymphoma, Leukemia, and Metastatic Disease. AJR Am J Roentgenol 2012; 199:W168-74. [DOI: 10.2214/ajr.11.7923] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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PET/CT and Renal Pathology: A Blind Spot for Radiologists? Part 1, Primary Pathology. AJR Am J Roentgenol 2012; 199:W163-7. [DOI: 10.2214/ajr.11.7790] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Makis W, Ciarallo A, Rakheja R, Probst S, Hickeson M, Rush C, Novales-Diaz JA, Derbekyan V, Stern J, Lisbona R. Spectrum of malignant renal and urinary bladder tumors on 18F-FDG PET/CT: a pictorial essay. Clin Imaging 2012; 36:660-73. [PMID: 23153993 DOI: 10.1016/j.clinimag.2012.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 12/30/2011] [Accepted: 01/03/2012] [Indexed: 11/18/2022]
Abstract
A wide variety of malignant renal and urinary bladder diseases can be detected on (18)F-FDG PET/CT. Although the PET/CT findings are often nonspecific, the aim of this atlas was to demonstrate that the spectrum of renal and urinary bladder malignancy that can be evaluated with PET/CT is much broader than current medical literature would suggest. PET/CT readers and oncologists should be aware of the variety of urological tumor types that can be detected on PET/CT and some of the patterns of (18)F-FDG uptake that can be observed in these cases.
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Affiliation(s)
- William Makis
- Department of Nuclear Medicine, Brandon Regional Health Centre, 150 McTavish Ave E, Brandon, MB, Canada R7A 2B3.
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Gardner TA, Tirkes T, Mellon M, Koch MO. Imaging techniques for the patient with renal cell carcinoma. Semin Nephrol 2011; 31:245-53. [PMID: 21784273 DOI: 10.1016/j.semnephrol.2011.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The imaging of renal cell carcinoma continues to evolve from radiographic tomography to state-of-the-art three-dimensional imagery using computed tomography (CT) or magnetic resonance imaging (MRI). This article reviews the current techniques of imaging the patient with renal cell carcinoma. Careful and accurate imaging of these patients allows for the appropriate diagnosis, treatment planning, and follow-up care. At each point in the care of these patients, imaging plays an important role. In particular, the diagnosis and staging of renal cell carcinoma can be accomplished with CT and MRI, with each modality having strengths and weaknesses that are contrasted. Intraoperative ultrasound is used during laparoscopic or conventional partial nephrectomies, whereas ultrasound, CT, and MRI can be used for guiding ablative technologies. Imaging also plays an important role in the follow-up care of these patients. The particular follow-up care is dependent on the stage and grade of the lesion and the treatment modality used. In summary, this article reviews the current imaging approaches for the diagnosis, staging, treatment, and follow-up care of patients with renal cell carcinoma.
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Affiliation(s)
- Thomas A Gardner
- Department of Urology, Indiana University, Indianapolis, IN 46202, USA.
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Abstract
CONTEXT Although lymphadenectomy (lymph node dissection [LND]) is currently accepted as the most accurate and reliable staging procedure for the detection of lymph node invasion (LNI), its therapeutic benefit in renal cell carcinoma (RCC) still remains controversial. OBJECTIVE Review the available literature concerning the role of LND in RCC staging and outcome. EVIDENCE ACQUISITION A Medline search was conducted to identify original articles, review articles, and editorials addressing the role of LND in RCC. Keywords included kidney neoplasms, renal cell cancer, renal cell carcinoma, kidney cancer, lymphadenectomy, lymph node excision, lymphatic metastases, nephrectomy, imaging, and complications. The articles with the highest level of evidence were identified with the consensus of all of the collaborative authors and were critically reviewed. This review is the result of an interactive peer-reviewing process by an expert panel of co-authors. EVIDENCE SYNTHESIS Renal lymphatic drainage is unpredictable. The newer available imaging techniques are still immature in detecting small lymph node metastases. Results from the European Organization for Research and Treatment of Cancer trial 30881 showed no benefit in performing LND during surgery for clinically node-negative RCC, but the results are limited to patients with the lowest risk of developing LNI. Numerous retrospective series support the hypothesis that LND may be beneficial in high-risk patients (clinical T3-T4, high Fuhrman grade, presence of sarcomatoid features, or coagulative tumor necrosis). If enlarged nodes are evident at imaging or palpable during surgery, LND seems justified at any stage. However, the extent of the LND remains a matter of controversy. CONCLUSIONS To date, the available evidence suggests that an extended LND may be beneficial when technically feasible in patients with locally advanced disease (T3-T4) and/or unfavorable clinical and pathologic characteristics (high Fuhrman grade, larger tumors, presence of sarcomatoid features, and/or coagulative tumor necrosis). Although node-positive patients often harbor distant metastases as well, the majority of retrospective nonrandomized trials seem to suggest a possible benefit of regional LND even for this group of patients. In patients with T1-T2, clinically negative lymph nodes and absence of unfavorable clinical and pathologic characteristics, regional LND offers limited staging information and no benefit in terms of decreasing disease recurrence or improving survival.
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