Nuclear medicine communications · 2025
Added value of delayed imaging after diuretic injection in evaluation of cases of bladder cancer with PET.
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Ibrahim Doaa, Abdelghaffar Alshaymaa, Nabil Hassan Emad Eldin
Аннотация
BACKGROUND: The clinical utility of 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (PET/CT) imaging in bladder cancer is often compromised by high urinary FDG accumulation, which can interfere with the accurate detection of primary tumors and metastatic sites. This study aimed to evaluate the added benefit of delayed PET/CT imaging after diuretic administration in patients with bladder cancer, focusing on its ability to overcome the limitations posed by high FDG excretion into the bladder.
METHODS: This prospective study was conducted at the Sohag Oncology Center, Egypt, and included patients with pathologically confirmed bladder cancer between March 2022 and March 2024. All patients underwent dual-phase PET/CT imaging, with early-phase imaging performed 45-90 min after the 18 F-FDG injection, followed by delayed imaging 1 h later after administering intravenous furosemide (20 mg) and enhanced hydration. The PET/CT images were analyzed qualitatively and quantitatively, with a maximum standardized uptake value (SUV max ) used to assess tumor activity in both early and delayed phases. Results were validated through biopsy, a combination of MRI and clinical follow-up for at least 6 months, or both.
RESULTS: A total of 39 patients were included in the study (33 males, 6 females, aged 42-80 years). Residual bladder lesions were observed in 12.8% of the early images and 58.9% of the delayed images, with a significant increase in SUV max ( P = 0.018). Lymph node involvement was detected in 12 patients, showing a similar rise in SUVmax ( P = 0.012). Also, delayed PET/CT imaging improved sensitivity for both bladder lesions and metastatic lymph nodes (92.6 and 93%, respectively), while maintaining specificity (100% for bladder lesions, 74% for lymph nodes).
CONCLUSION: Delayed PET/CT postdiuretic administration improves image quality in bladder cancer via reducing urinary radiotracer activity, thus minimizing bladder interference and improving lesion detectability and characterization.
METHODS: This prospective study was conducted at the Sohag Oncology Center, Egypt, and included patients with pathologically confirmed bladder cancer between March 2022 and March 2024. All patients underwent dual-phase PET/CT imaging, with early-phase imaging performed 45-90 min after the 18 F-FDG injection, followed by delayed imaging 1 h later after administering intravenous furosemide (20 mg) and enhanced hydration. The PET/CT images were analyzed qualitatively and quantitatively, with a maximum standardized uptake value (SUV max ) used to assess tumor activity in both early and delayed phases. Results were validated through biopsy, a combination of MRI and clinical follow-up for at least 6 months, or both.
RESULTS: A total of 39 patients were included in the study (33 males, 6 females, aged 42-80 years). Residual bladder lesions were observed in 12.8% of the early images and 58.9% of the delayed images, with a significant increase in SUV max ( P = 0.018). Lymph node involvement was detected in 12 patients, showing a similar rise in SUVmax ( P = 0.012). Also, delayed PET/CT imaging improved sensitivity for both bladder lesions and metastatic lymph nodes (92.6 and 93%, respectively), while maintaining specificity (100% for bladder lesions, 74% for lymph nodes).
CONCLUSION: Delayed PET/CT postdiuretic administration improves image quality in bladder cancer via reducing urinary radiotracer activity, thus minimizing bladder interference and improving lesion detectability and characterization.