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Nuklearmedizin 2015; 54(01): 36-42
DOI: 10.3413/Nukmed-0652-14-03
Original article
Schattauer GmbH

Reduction of bladder activity on FDG PET/CT scan in patients with urinary bladder carcinoma

A prospective study with a patient-friendly protocolReduktion der Blasenaktivität auf FDG-PET/CT-Aufnahmen bei Patienten mit BlasenkarzinomProspektive Studie mit einem Patientenfreundlichem Protokoll
S.-C. Tsai
1   Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
2   Institute of Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
,
Y.-C. Ou
3   Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
,
C.-L. Cheng
3   Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
,
J.-R. Li
3   Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
4   Institute of Medical and Molecular Toxicology, Chung Shan Medical University
,
Y.-C. Lin
1   Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
,
H.-C. Ho
3   Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
,
K.-Y. Chiu
3   Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
,
C.-K. Su
3   Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
,
W.-Y. Lin   *
1   Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
2   Institute of Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
› Author Affiliations
Further Information

Publication History

received: 23 March 2014

accepted in revised form: 10 September 2014

Publication Date:
26 December 2017 (online)

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Summary

Oral hydration with large volume of fluid, high dose of diuretics and maximum bladder distension are frequently required to achieve an adequate urinary FDG clearance in an FDG PET/CT protocol for bladder cancer or pelvic tumour evaluation. Although most patients tolerated these procedures for eliminating urinary FDG activity, these procedures may be still unpleasant. Aim: Is there a more patient-friendly protocol which is less burdensome and yet provides a satisfactory FDG clearance in urine? In this study, we established a patient-friendly FDG PET/CT protocol without compromising urinary FDG clearance. Patients, methods: 23 patients with biopsy-proven urinary bladder cancers were recruited to evaluate the effectiveness of this patient-friendly protocol on reducing urinary bladder FDG activity. The patient-friendly protocol includes encouraging patients to take a tolerable amount of fluid, delaying the administration of low dose diuretic, shortening the urine holding time and using delayed imaging. Results: All of the patients tolerated this patient-friendly procedure well. In addition, the patient-friendly protocol was effective in reducing FDG activity in the urine. One hundred percent of primary bladder cancer were visualized on the FDG PET/CT images using this patient-friendly protocol. Conclusions: This patient-friendly FDG PET/CT protocol is less intrusive yet effective in reducing urinary FDG activity.

Zusammenfassung

Häufig sind orale Hydrierung mit großen Flüssigkeitsmengen, hohe Diuretikadosen und maximale Blasenfüllung notwendig, um in einem FDG-PET/CT-Protokoll zur Beurteilung eines Blasenkarzinoms oder Tumors im Becken eine adäquate FDG Clearance zu erreichen. Patienten haben diese Maßnahmen zu Elimination der FDG-Aktivität aus den Harnwegen zwar meist toleriert, diese können jedoch unangenehm sein. Ziel: Gibt es ein Patientenfreundlicheres Protokoll, weniger belastend und dennoch mit zufriedenstellender FDGClearance im Urin? In dieser Studie führten wir ein Patienten-freundliches FDG-PET/CTProtokoll ein, ohne die FDG-Clearance im Urin zu gefährden. Patienten: 23 Patienten mit bioptisch gesichertem Harnblasenkrebs wurden rekrutiert, um die Effektivität dieses Patienten-freundlichen Protokolls auf die Reduktion der FDG-Aktivität in der Harnblase zu untersuchen. Das Patienten-freundliche Protokoll sah u.a. vor, die Patienten aufzufordern, so viel sie können zu trinken, niedrig dosierte Diuretika später zu geben, den Urin über eine kürzere Zeit einzuhalten und die Bildaufnahme zu verzögern. Ergebnisse: Dieses Patienten-freundliche Verfahren war für alle Teilnehmer gut verträglich. Außerdem konnte die FDG-Aktivität im Urin effektiv gesenkt werden. Hundert Prozent der primären Blasenkarzinome konnten mit diesem Patienten- freundlichen Protokoll auf den FDG-PET/ CT-Aufnahmen sichtbar gemacht werden. Schussfolgerungen: Dieses Patienten-freundliche FDG-PET/CT-Protokoll ist weniger aggressiv und senkt dennoch effektiv die FDGAktivität im Urin.

Keywords

Bladder cancer - FDG PET/CT - urinary FDG activity - protocol

Schlüsselwörter

Blasenkrebs - FDG-PET/CT - FDG-Aktivität im Urin - Protokoll

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  • References

  • 1 Anjos DA, Etchebehere ECSC, Ramos CD. et al. 18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer. J Nucl Med 2007; 48: 764-770.
    CrossrefPubMedGoogle Scholar
  • 2 Bachor R, Kotzerke J, Reske SN, Hautmann R. Lymph node staging of bladder neck carcinoma with positron emission tomography. Urologe A 1999; 38: 46-50.
    CrossrefPubMedGoogle Scholar
  • 3 Drieskens O, Oyen R, Van Poppel H. et al. FDG-PET for preoperative staging of bladder cancer. Eur J Nucl Med Mol Imaging 2005; 32: 1412-1417.
    CrossrefPubMedGoogle Scholar
  • 4 Harkirat S, Anand SS, Jacob MJ. Forced diuresis and dual-phase 18F-fluorodeoxyglucose-PET/CT scan for restaging of urinary bladder cancers. Indian J Radiol Imaging 2010; 20: 13-19.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Heicappell R, Müller-Mattheis V, Reinhardt M. et al. Staging of pelvic lymph nodes in neoplasms of the bladder and prostate by positron emission tomography with 2-[18F]-2-deoxy-D-glucose. Eur Urol 1999; 36: 582-587.
    CrossrefPubMedGoogle Scholar
  • 6 Jadvar H, Quan V, Henderson RW, Conti PS. [F-18]-Fluorodeoxyglucose PET and PET-CT in diagnostic imaging evaluation of locally recurrent and metastatic bladder transitional cell carcinoma. Int J Clin Oncol 2008; 13: 42-47.
    CrossrefPubMedGoogle Scholar
  • 7 Kibel AS, Dehdashti F, Katz MD. et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol 2009; 27: 4314-4320.
    CrossrefPubMedGoogle Scholar
  • 8 Kosuda S, Kison PV, Greenough R. et al. Preliminary assessment of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with bladder cancer. Eur J Nucl Med 1997; 24: 615-620.
    PubMedGoogle Scholar
  • 9 Koyama K, Okamura T, Kawabe J. et al. Evaluation of 18F-FDG PET with bladder irrigation in patients with uterine and ovarian tumors. J Nucl Med 2003; 44: 353-358.
    PubMedGoogle Scholar
  • 10 Lin WY, Wang KB, Tsai SC, Sun SS. Unexpected accumulation of F-18 FDG in the urinary bladder after bladder irrigation and retrograde filling with sterile saline: a possible pitfall in PET examination. Clin Nucl Med 2009; 34: 560-563.
    CrossrefPubMedGoogle Scholar
  • 11 Liu IJ, Lai YH, Espiritu JI. et al. Evaluation of fluorodeoxyglucose positron emission tomography imaging in metastatic transitional cell carcinoma with and without prior chemotherapy. Urol Int 2006; 77: 69-75.
    CrossrefPubMedGoogle Scholar
  • 12 Mertens LS, Bruin NM, Vegt E. et al. Catheter-assisted F-18 FDG-PET/CT imaging of primary bladder cancer: a prospective study. Nucl Med Commun 2012; 33: 1195-1201.
    CrossrefPubMedGoogle Scholar
  • 13 Moran JK, Lee HB, Blaufox MD. Optimization of urinary FDG excretion during PET imaging. J Nucl Med 1999; 40: 1352-1357.
    PubMedGoogle Scholar
  • 14 Nayak B, Dogra PN, Naswa N, Kumar R. Diuretic F-18 FDG PET/CT imaging for detection and locoregional staging of urinary bladder cancer: prospective evaluation of a novel technique. Eur J Nucl Med Mol Imaging 2013; 40: 386-393.
    CrossrefPubMedGoogle Scholar
  • 15 Nijjar S, Patterson J, Ducharme J. et al. The effect of furosemide dose timing on bladder activity in oncological imaging with F-18 fluorodeoxyglucose PET/CT. Nucl Med Commun 2010; 31: 167-172.
    CrossrefPubMedGoogle Scholar
  • 16 Yang Z, Cheng J, Pan L. et al. Is whole-body fluorine-18 fluorodeoxyglucose PET/CT plus additional pelvic images (oral hydration-voiding-refilling) useful for detecting recurrent bladder cancer?. Ann Nucl Med 2012; 26: 571-577.
    CrossrefPubMedGoogle Scholar