|Year : 2018 | Volume
| Issue : 1 | Page : 20-27
PET-CT and PET-MR in urological cancers other than prostate cancer: An update on state of the art
Abdul Razik, Chandan Jyoti Das, Sanjay Sharma
Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||03-Nov-2017|
|Date of Acceptance||11-Dec-2017|
|Date of Web Publication||29-Dec-2017|
Chandan Jyoti Das
Department of Radiology, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Hybrid positron emission tomography with computed tomography (PET/CT) and magnetic resonance imaging (PET/MRI) have enabled the combination of morphologic and functional imaging with the promise of providing better information in guiding therapy. Further advance has been made in the past decade with the development of newer radiotracers and optimization of the technical aspects. We performed a search in PubMed, Scopus, and Google Scholar for peer-reviewed literature concerning the advances and newer developments in the imaging of nonprostate urologic cancers between 2005 and 2017. This review aims at summarizing the current evidence on PET imaging in nonprostate urologic cancers and their impact on the diagnosis, staging, prognostication, response assessment, and restaging of these malignancies. However, much of the evidence is still in infancy and has not been incorporated into routine management or the practice guidelines of National Comprehensive Cancer Network or European Society for Medical Oncology (ESMO).
|How to cite this article:|
Razik A, Das CJ, Sharma S. PET-CT and PET-MR in urological cancers other than prostate cancer: An update on state of the art. Indian J Urol 2018;34:20-7
|How to cite this URL:|
Razik A, Das CJ, Sharma S. PET-CT and PET-MR in urological cancers other than prostate cancer: An update on state of the art. Indian J Urol [serial online] 2018 [cited 2020 Feb 21];34:20-7. Available from: http://www.indianjurol.com/text.asp?2018/34/1/20/221972
| Introduction|| |
Urological oncology is an active field in imaging research, and many modalities have been evaluated in the past few decades for the detection, characterization, and staging of urologic cancers. Metabolic imaging with PET has been evaluated for its ability to outperform conventional imaging modalities in urologic cancers. With the advent of hybrid positron emission tomography with computed tomography (PET/CT) and magnetic resonance imaging (PET/MRI), morphologic and functional imaging has been combined with the promise of providing better information in guiding therapy. This review aims at summarizing the current evidence on PET imaging in nonprostate urologic cancers and their impact on the diagnosis, staging, prognostication, response assessment, and restaging of these malignancies.
| Renal Cancer|| |
Contrast-enhanced CT (CECT) is the imaging modality of choice in the preoperative workup of patients with renal cell carcinoma (RCC). It provides information on the local extent, lymph node and vascular involvement, multifocality as well as distant metastasis. Any enhancing mass in the kidney is considered RCC and is seldom biopsied. Biopsy, at present, is limited to patients having extensive metastatic disease or significant comorbidities which preclude surgery, imaging features classical of triphasic angiomyolipoma, suspicious lymphoma, renal metastasis or infection, and in masses smaller than 3 cm where percutaneous or laparoscopic ablation may be considered. CECT has limited value in differentiating benign from malignant masses or in the grading of tumor. 18F-fluorodeoxyglucose (18 F-FDG) PET/CT plays an important role in the preoperative workup of patients with RCC. In a meta-analysis, Wang et al. noted that FDG PET had a pooled sensitivity and specificity of 62% and 88% for renal lesions and 79% and 90% for extrarenal lesions. The lower performance in detecting renal lesions has been hypothesized to be secondary to obscuration by urinary FDG activity. Takahashi observed that based on the SUV values, PET/CT could differentiate high-grade from low-grade tumors with cutoff SUVmax of 3.0 having sensitivity and specificity of 89% and 87%, respectively. Nakajima et al. found that higher FDG uptake correlated with higher Fuhrman grade, higher tumor, node, metastasis stage, and the presence of vascular and lymphatic invasion. Similar results have been observed by multiple authors.,,,
In addition, it is sometimes possible to differentiate malignant renal tumors from benign etiologies. High-grade clear-cell RCC and papillary RCC had significantly higher SUV values than normal renal tissue whereas low-grade RCC and chromophobe RCC did not. SUVmax of 2.2 had sensitivity and specificity of 65% and 89% in differentiating benign and malignant tumors. One study used dual tracer (11 C-acetate and 18 F-FDG) PET and observed that low-grade RCC, chromophobe RCC, and low-grade clear-cell RCC showed high uptake on 11 C-acetate PET and poor uptake with 18 F-FDG, whereas opposite results were obtained with papillary RCC and high-grade clear-cell RCC. Schuster et al. noted that papillary RCC showed uptake with the leucine analog radiotracer 18 F-FACBC, unlike other RCC subtypes.
PET/CT can detect metastasis in subcentimetric nodes, which are not considered significant on CECT. PET/CT also can differentiate tumor thrombus from bland thrombus using cutoff SUVmax values. It has a well-established role, better than CT in detecting and quantifying the metastatic burden in RCC, thereby having a significant impact on the management.,, Even a single, doubtful metastatic lesion on CT can be evaluated with PET/CT. There is a significant difference in the SUVmax of RCC with and without metastasis. PET/CT is better than 99 Tc-MDP bone scan in evaluating bone metastasis as many of these lesions are osteolytic and missed on bone scan, whereas FDG uptake depends on metabolic rather than osteoblastic activity. The ability of FDG PET to assess tumor grade and metastatic burden has enabled prediction of prognosis and survival in RCC.,, Recently, multiple studies confirmed the usefulness of 68 Ga PSMA PET as well as the PSMA targeted ligand 18 F-DCFPyl in the staging of RCC.,,
PET/CT has an important role in the active surveillance of patients after radical nephrectomy in detecting local or systemic recurrence.,, Since PET/CT can evaluate all organ systems in one examination and does not require contrast, it could replace the conventional imaging modalities in restaging RCC. In a large meta-analysis, Ma et al. demonstrated pooled sensitivity and specificity of 86% and 88% in the restaging of RCC. False-negative cases are largely due to small size of the lesion and limited spatial resolution of the scanner. False-positive results occur due to concomitant infection, postoperative scar, or postradiation inflammation., In a study of 104 patients with proven recurrence after surgery, Alongi et al. observed the sensitivity and specificity of FDG-PET to be 74% and 80%, respectively, with the PET findings having influenced the management in 43% of the patients. Positive PET was associated with worse survival rates over a period of 5 years. Park et al. noted that the positivity on FDG-PET in recurrence was not influenced by the nuclear grade of the tumor. Nakatani et al. observed that the sensitivity rose to 100% for recurrent papillary RCC as against other subtypes.
Advanced, unresectable RCC is resistant to conventional chemotherapy and radiotherapy. Tyrosine kinase inhibitors (TKIs) such as sunitinib and sorafenib are effective in such cancers; however, the estimation of response assessment using mere size criteria might be fallacious with some even showing an early increase in size despite response. PET/CT might have a role in the early prediction of response and survival in such patients.,, Kayani et al. observed that 57% of RCC cases treated with sunitinib showed FDG PET/CT response (defined as 20% reduction in SUVmax) at 4 weeks, but only the results at 16 weeks were prognostically significant. Response with TKI was seen regardless of the site of metastasis and this did not have a bearing on the initiation of TKI. Farnebo et al. observed that volumetric FDG-PET assessment using SULpeak and total lesion glycolysis predicted progression-free survival (PFS) and overall survival (OS) as early as 14 days after initiation of therapy, whereas SUVmax did not. Several other tracers have been used in assessing response to TKI.
Hugonnet et al. used 18 F-fluoromisonidazole (FMISO) PET, a marker of hypoxia, to assess response to TKI and observed that patients with initially hypoxic tumors had shorter PFS. The uptake on 18 F-FMISO PET decreased 1 month after initiation of TKI and suggested response. Horn et al., in a study comparing 18 F-fluorothymidine (FLT) PET (a marker of cellular proliferation) and 18 F-FDG PET, observed that response was seen at an earlier time point with FLT-PET. This suggested that TKI halted tumor proliferation earlier than glycolytic metabolism. Similarly,18 F-fluoroethylcholine PET,11 C-acetate PET, and 68 Ga-PSMA PET also have also been evaluated in response assessment in RCC.,, The preliminary results of a study by Antunes et al. suggest that radiomics analysis on PET/MRI could be a powerful tool in evaluating response assessment of RCC. Of late, carbonic anhydrase IX (CAIX) has been a topic of active investigation in RCC. Mutation of VHL leads to CAIX expression in most clear-cell RCCs. ImmunoPET with radiolabelled antibodies to CAIX has been observed in ex vivo and in vivo studies to identify clear-cell RCC lesions, act as a favorable prognostic biomarker and help guide radioimmunotherapy. Clinical studies are in the infancy with one multicenter study that used 124 I-girentuximab (cG250) PET having reported sensitivity and specificity of 86.2% and 85.9%.
In summary, currently, there is not enough evidence to support the use of FDG-PET in the initial diagnosis or local staging of RCC. However, it is useful in the distant staging of RCC, restaging after surgery as well as in the assessment of response to chemotherapy. None of the guidelines from international policy-making bodies (European Society for Medical Oncology [ESMO] or National Comprehensive Cancer Network [NCCN]) support its routine use. The newer tracers hold promise, however, are experimental at present and require larger studies.
| Malignant Adrenal Tumors|| |
The most common imaging modalities used to evaluate adrenal masses are CECT and MRI. Adrenal protocol in CT involves unenhanced imaging followed by venous phase (60–70s) and delayed phase (15 min) imaging. An unenhanced attenuation of less than 10HU, absolute and relative percentage washout more than 60% and 40%, respectively, are suggestive of adenoma. Similar is the case for a mass that shows significant loss of signal in opposed-phase images as compared to in-phase MR images. PET/CT also has been evaluated in adrenal mass evaluation. Several initial studies used quantitative parameters (SUV cutoff and adrenal to liver mean SUV ratio) in differentiating benign and malignant adrenal masses., A large meta-analysis of 1391 lesions suggested that mere qualitative assessment of PET/CT had sensitivity and specificity of 97% and 91% in characterizing an adrenal mass as malignant. Qualitative analysis was found to be variable and not required in evaluating an adrenal mass but was considered helpful in assessing therapeutic response. False-negative results were rare and benign lesions causing marked FDG avidity were extremely unusual. However, false-positive cases were seen with few adenomas and infections, which showed mild FDG uptake (greater than the liver uptake) and the authors recommended caution while labeling these as outright benign or malignant. Such lesions need to be assessed further with CT densitometry, contrast washout characteristics, MRI or follow-up imaging. Percutaneous biopsy must be resorted to if earlier characterization is required. In another study, when both CECT and PET/CT criteria where used to characterize adrenal masses in oncologic patients, positivity in both increased the specificity for the diagnosis of metastasis to 91.2%, at the cost of decreased specificity (70.6%). However, Brady et al. noted that combining unenhanced CT and SUV cutoff of 10 HU and 3.1, respectively, increased specificity by reducing the false-positive cases without sacrificing sensitivity.
A multicenter retrospective study of malignant adrenal lesions showed that PET/CT had better accuracy than CECT in the diagnosing malignancy in case of adrenocortical carcinomas (ACC), lymphomas and neuroblastomas, and similar accuracy in case of malignant pheochromocytomas. However, till date, PET/CT is not useful in differentiating the different malignant subtypes. In the workup of ACC, PET/CT is able to detect more distant metastasis than CECT., PET/CT is also helpful in identifying metastasis which are occult on CT, as well as in accurately targeting biopsies in tumors with hemorrhage and necrosis, as well as in collision tumors. In malignant pheochromocytomas, PET/CT was better than 131 I-MIBG SPECT/CT in identifying high-grade tumors, since the latter showed uptake only in well-differentiated tumors. PET/CT also was better at detecting metastasis.,
Takeuchi et al. showed that PET/CT and CECT fare similarly in the detection of primary and recurrent ACC; however, PET/CT could change the management in a small number of patients who were negative on CECT. PET/CT was also better than CECT in response assessment as decrease in tumor metabolism occurred before the reduction in size. However, no PET/CT parameters could predict survival at initial diagnosis or in recurrence. Ardito found PET/CT to be less sensitive than CECT in detection of lung and liver recurrences of ACC; however, since PET/CT was more specific, it influenced the management in patients who were negative on PET/CT and positive on CECT.
| Pelvic and Ureteric Cancers|| |
Evaluation of primary tumors of the pelviureteric system by FDG-PET is limited because of the normal urinary activity, especially in small tumors. Despite this, Asai et al. observed a sensitivity of 83% for upper urinary tract urothelial cancers, with no correlation between the uptake and tumor stage/grade. PET/CT is superior to CECT in the detection of distant metastasis and influenced the management in a significant number of patients. One study observed better OS and PFS for patients who showed response on PET/CT after two cycles of first-line chemotherapy. PET/CT is also more accurate than CECT for detecting local and distant recurrence postsurgery.
| Bladder Cancer|| |
PET evaluation of bladder cancers is limited by the urinary activity which obscures tumors and limits detection and locoregional staging. Cystoscopy is the gold standard in screening for bladder masses in patients who are positive on cytology. MRI is more sensitive to picking up bladder tumors than CECT or PET/CT. In a meta-analysis, Wang et al. showed a pooled sensitivity of 80% for FDG PET/CT in detecting bladed cancers. Lodde at al observed PET/CT to be slightly more sensitive than CECT to the detection of bladder cancer (85% vs. 77%), but less specific (25% vs. 50%). For detection of nodal metastasis, PET/CT was more sensitive (57% vs. 33%) but equally specific (100%). Subsequently, several authors tried oral hydration and delayed imaging to increase detection rate., Nayak et al. evaluated FDG PET/CT postforced diuresis with 20–40 mg of Furosemide, which improved conspicuity of the lesions with better sensitivity to detection of the primary tumor and pelvic lymph nodes than CECT (96% and 78% vs. 92% and 44%). PET/CT has no role in prediction of muscle invasion in bladder cancer for which cystoscopy guided deep muscle biopsy remains the gold standard.
PET/CT has established role in metastatic workup of bladder cancer. Muscle-invasive bladder cancers require radical cystectomy, a morbid procedure. Detection of distant metastasis avoids surgery and can have therapeutic impact. A meta-analysis showed pooled sensitivity and specificity of 82% and 89% for PET/CT in detecting metastasis in primary and recurrent bladder tumors. Mertens et al. noted that the better detection of metastasis altered the management in 20% of their patients with muscle-invasive tumors. Similar observations were made by multiple other authors.,, Another study observed that the presence of PET-avid extravesical lesions was associated with poor OS in patients with muscle-invasive cancers. PET/CT has also been used in assessing response to neoadjuvant therapy. PET responders on chemotherapy have been observed to have better survival. PET/CT is also valuable in restaging bladder cancer postradical cystectomy, in detecting both local recurrence and distant metastasis.
11 C-choline PET was introduced into bladder cancer imaging due to its little urinary excretion and was expected to be a promising tracer., However, most subsequent studies failed to observe significant improvement over CECT or FDG PET/CT.,11 C-methionine and 11 C-acetate PET/CT also have been evaluated and found to be better than FDG PET/CT in the detection of primary tumor and nodal metastasis. However, the evidence with these agents is insufficient to recommend routine usage.,
PET/MRI holds promise due to its superior soft-tissue resolution and increased the confidence with which metastatic lesions can be diagnosed. Usage of dynamic contrast enhanced as well as diffusion-weighted MRI can improve the detection of local tumor, nodal, and distant metastasis as well as prediction of muscle-invasion.,
In summary, FDG-PET is not useful in the local diagnosis or staging of bladder cancer. However, there is good evidence supporting its usefulness in the distant metastatic assessment of primary as well as recurrent cancer. Newer tracers are promising but lack sufficient evidence to support routine use. Neither NCCN nor ESMO guidelines support the routine use of PET in bladder cancer.
| Testicular Tumors|| |
Currently, CECT is used for staging and response assessment. Subcentimetric RP nodes are common in CECT of the abdomen. Detection of micrometastasis in subcentimetric lymph nodes is not possible on CECT, which relies on size and morphologic criteria. In addition, residual soft tissue is consistently visualized in the postchemotherapy CT of patients with complete response and has been attributed to fibrosis. CECT is limited in the differentiation of fibrosis and residual tumor. Hence, PET/CT has been extensively evaluated in the staging as well as restaging of testicular cancers. Ambrosini et al. observed PET/CT to have good sensitivity and specificity for detection of Seminoma lesions (92% and 84%, respectively), however, the sensitivity was lower for non-seminoma lesions (77%). PET/CT influenced the management in a significant number of patients for both the types. Tregalia et al. performed a large meta-analysis and observed PET/CT to have a pooled sensitivity and specificity of 78% and 86% in the assessment of postchemotherapy residual lesions. They noted PET/CT to have a high negative predictive value and the lesions missed are mostly subcentimetric. The authors recommend only follow-up for PET-negative lesions, even when they are larger than the CT cutoff size of 3 cm. Similar results were observed by multiple other authors.,, False-positive results were high, largely due to posttreatment inflammatory changes. Hence, an interval of 6 weeks should be kept between the end of chemotherapy and the PET/CT to reduce inflammatory changes., Since mature teratomas do not show FDG uptake, PET/CT is not recommended in the response assessment of non-seminomatous tumors.
PET has validated role in the follow-up of seminomatous germ cell tumors. As per the ESMO and NCCN guidelines, FDG-PET is recommended 6 weeks' postchemotherapy for residual masses larger than 3 cm. For smaller masses, PET may be performed however, the positive predictive value is lower and surveillance is preferred. PET is not recommended in the initial staging of testicular tumors or the follow-up of nonseminomatous tumors.
| Penile Cancer|| |
The role of PET/CT in the evaluation of penile cancer is ambiguous. Almost all cancers show uptake on PET; however, PET/CT is not recommended for primary tumor staging. Multiple studies have used PET/CT in the detection of micrometastasis in clinically N0 disease (non-palpable nodes) and found variable, but generally low sensitivity.,, One meta-analysis showed pooled sensitivity of only 57%, which makes surgical staging necessary despite its morbidity. The same study observed a pooled sensitivity of 96% for clinically palpable nodes. For pelvic lymph node as well as distant metastatic assessment, PET/CT is extremely useful and more accurate than CECT. The performance is better if palpably enlarged inguinal lymph nodes are present. However, the evidence is insufficient and is not recommended by NCCN or ESMO as of now.
| Conclusion|| |
Metabolic imaging with FDG PET is limited in urologic cancers because of the high urinary activity of the radiotracer. Metabolic imaging with PET/CT and PET/MRI is advancing with newer tracers being discovered and tested. The need to optimize technical factors in hybrid PET/MRI for the best results is also a challenge to be dealt with. Combining the metabolic data of PET with MRI holds great promise; however, sufficient evidence supporting its routine use is not available at present except in the follow-up of seminomatous germ cell tumors of the testis. A summary of the potential applications of FDG-PET, newer tracers, and the current ESMO/NCCN guidelines are provided in [Table 1].
|Table 1: Summary of the currently available radiotracers, their functions, potential applications, and European Society for Medical Oncology/National Comprehensive Cancer Network practice recommendations in urologic cancers|
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| References|| |
Caoili EM, Davenport MS. Role of percutaneous needle biopsy for renal masses. Semin Intervent Radiol 2014;31:20-6.
Wang HY, Ding HJ, Chen JH, Chao CH, Lu YY, Lin WY, et al.
Meta-analysis of the diagnostic performance of [18F] FDG-PET and PET/CT in renal cell carcinoma. Cancer Imaging 2012;12:464-74.
Takahashi M, Kume H, Koyama K, Nakagawa T, Fujimura T, Morikawa T, et al.
Preoperative evaluation of renal cell carcinoma by using 18F-FDG PET/CT. Clin Nucl Med 2015;40:936-40.
Nakajima R, Abe K, Kondo T, Tanabe K, Sakai S. Clinical role of early dynamic FDG-PET/CT for the evaluation of renal cell carcinoma. Eur Radiol 2016;26:1852-62.
Wang R, Di L. Prediction value of 18F-FDG PET/CT for nuclear grade in renal clear cell carcinoma patients. J Nucl Med 2017;58 Suppl 1:1071.
Onishi R, Noguchi M, Kaida H, Moriya F, Chikui K, Kurata S, et al.
Assessment of cell proliferation in renal cell carcinoma using dual-phase 18
F-fluorodeoxyglucose PET/CT. Oncol Lett 2015;10:822-8.
Noda Y, Kanematsu M, Goshima S, Suzui N, Hirose Y, Matsunaga K, et al.
18-F fluorodeoxyglucose uptake in positron emission tomography as a pathological grade predictor for renal clear cell carcinomas. Eur Radiol 2015;25:3009-16.
Mizuno T, Kamai T, Abe H, Sakamoto S, Kitajima K, Nishihara D, et al.
Clinically significant association between the maximum standardized uptake value on 18F-FDG PET and expression of phosphorylated Akt and S6 kinase for prediction of the biological characteristics of renal cell cancer. BMC Cancer 2015;15:1097.
Ho CL, Chen S, Ho KM, Chan WK, Leung YL, Cheng KC, et al.
Dual-tracer PET/CT in renal angiomyolipoma and subtypes of renal cell carcinoma. Clin Nucl Med 2012;37:1075-82.
Schuster DM, Nye JA, Nieh PT, Votaw JR, Halkar RK, Issa MM, et al.
Initial experience with the radiotracer anti-1-amino-3-[18F] Fluorocyclobutane-1-carboxylic acid (anti-[ 18F] FACBC) with PET in renal carcinoma. Mol Imaging Biol 2009;11:434-8.
Liu Y. The place of FDG PET/CT in renal cell carcinoma: Value and limitations. Front Oncol 2016;6:201.
Sharma P, Kumar R, Jeph S, Karunanithi S, Naswa N, Gupta A, et al.
18F-FDG PET-CT in the diagnosis of tumor thrombus: Can it be differentiated from benign thrombus? Nucl Med Commun 2011;32:782-8.
Ozülker T, Ozülker F, Ozbek E, Ozpaçaci T. A prospective diagnostic accuracy study of F-18 fluorodeoxyglucose-positron emission tomography/computed tomography in the evaluation of indeterminate renal masses. Nucl Med Commun 2011;32:265-72.
Ma H, Shen G, Liu B, Yang Y, Ren P, Kuang A, et al.
Diagnostic performance of 18F-FDG PET or PET/CT in restaging renal cell carcinoma: A systematic review and meta-analysis. Nucl Med Commun 2017;38:156-63.
Rodríguez Martínez de Llano S, Jiménez-Vicioso A, Mahmood S, Carreras-Delgado JL. Clinical impact of (18) F-FDG PET in management of patients with renal cell carcinoma. Rev Esp Med Nucl 2010;29:12-9.
Aide N, Cappele O, Bottet P, Bensadoun H, Regeasse A, Comoz F, et al.
Efficiency of [(18)F] FDG PET in characterising renal cancer and detecting distant metastases: A comparison with CT. Eur J Nucl Med Mol Imaging 2003;30:1236-45.
Lee H, Hwang KH, Kim SG, Koh G, Kim JH. Can initial (18) F-FDG PET-CT imaging give information on metastasis in patients with primary renal cell carcinoma? Nucl Med Mol Imaging 2014;48:144-52.
Win AZ, Aparici CM. Clinical effectiveness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in management of renal cell carcinoma: A single institution experience. World J Nucl Med 2015;14:36-40.
] [Full text]
Ferda J, Ferdova E, Hora M, Hes O, Finek J, Topolcan O, et al.
18F-FDG-PET/CT in potentially advanced renal cell carcinoma: A role in treatment decisions and prognosis estimation. Anticancer Res 2013;33:2665-72.
Namura K, Minamimoto R, Yao M, Makiyama K, Murakami T, Sano F, et al.
Impact of maximum standardized uptake value (SUVmax) evaluated by 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) on survival for patients with advanced renal cell carcinoma: A preliminary report. BMC Cancer 2010;10:667.
Yoon HJ, Paeng JC, Kwak C, Park YH, Kim TM, Lee SH, et al.
Prognostic implication of extrarenal metabolic tumor burden in advanced renal cell carcinoma treated with targeted therapy after nephrectomy. Ann Nucl Med 2013;27:748-55.
Rhee H, Blazak J, Tham CM, Ng KL, Shepherd B, Lawson M, et al.
Pilot study: Use of gallium-68 PSMA PET for detection of metastatic lesions in patients with renal tumour. EJNMMI Res 2016;6:76.
Gorin MA, Rowe SP. Kidney cancer: PSMA: A potential therapeutic target in RCC. Nat Rev Urol 2017;14:646-7.
Rowe SP, Gorin MA, Hammers HJ, Som Javadi M, Hawasli H, Szabo Z, et al.
Imaging of metastatic clear cell renal cell carcinoma with PSMA-targeted 1
F-DCFPyL PET/CT. Ann Nucl Med 2015;29:877-82.
Fuccio C, Ceci F, Castellucci P, Spinapolice EG, Palumbo R, D'Ambrosio D, et al.
Restaging clear cell renal carcinoma with 18F-FDG PET/CT. Clin Nucl Med 2014;39:e320-4.
Kumar R, Shandal V, Shamim SA, Jeph S, Singh H, Malhotra A, et al.
Role of FDG PET-CT in recurrent renal cell carcinoma. Nucl Med Commun 2010;31:844-50.
Bertagna F, Motta F, Bertoli M, Bosio G, Fisogni S, Tardanico R, et al.
Role of F18-FDG-PET/CT in restaging patients affected by renal carcinoma. Nucl Med Rev Cent East Eur 2013;16:3-8.
Alongi P, Picchio M, Zattoni F, Spallino M, Gianolli L, Saladini G, et al.
Recurrent renal cell carcinoma: Clinical and prognostic value of FDG PET/CT. Eur J Nucl Med Mol Imaging 2016;43:464-73.
Park JW, Jo MK, Lee HM. Significance of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography for the postoperative surveillance of advanced renal cell carcinoma. BJU Int 2009;103:615-9.
Nakatani K, Nakamoto Y, Saga T, Higashi T, Togashi K. The potential clinical value of FDG-PET for recurrent renal cell carcinoma. Eur J Radiol 2011;79:29-35.
Caldarella C, Muoio B, Isgrò MA, Porfiri E, Treglia G, Giovanella L, et al.
The role of fluorine-18-fluorodeoxyglucose positron emission tomography in evaluating the response to tyrosine-kinase inhibitors in patients with metastatic primary renal cell carcinoma. Radiol Oncol 2014;48:219-27.
Lyrdal D, Boijsen M, Suurküla M, Lundstam S, Stierner U. Evaluation of sorafenib treatment in metastatic renal cell carcinoma with 2-fluoro-2-deoxyglucose positron emission tomography and computed tomography. Nucl Med Commun 2009;30:519-24.
Ueno D, Yao M, Tateishi U, Minamimoto R, Makiyama K, Hayashi N, et al.
Early assessment by FDG-PET/CT of patients with advanced renal cell carcinoma treated with tyrosine kinase inhibitors is predictive of disease course. BMC Cancer 2012;12:162.
Kayani I, Avril N, Bomanji J, Chowdhury S, Rockall A, Sahdev A, et al.
Sequential FDG-PET/CT as a biomarker of response to sunitinib in metastatic clear cell renal cancer. Clin Cancer Res 2011;17:6021-8.
Kakizoe M, Yao M, Tateishi U, Minamimoto R, Ueno D, Namura K, et al.
The early response of renal cell carcinoma to tyrosine kinase inhibitors evaluated by FDG PET/CT was not influenced by metastatic organ. BMC Cancer 2014;14:390.
Farnebo J, Grybäck P, Harmenberg U, Laurell A, Wersäll P, Blomqvist LK, et al.
Volumetric FDG-PET predicts overall and progression- free survival after 14 days of targeted therapy in metastatic renal cell carcinoma. BMC Cancer 2014;14:408.
Hugonnet F, Fournier L, Medioni J, Smadja C, Hindié E, Huchet V, et al.
Metastatic renal cell carcinoma: Relationship between initial metastasis hypoxia, change after 1 month's sunitinib, and therapeutic response: An 18F-fluoromisonidazole PET/CT study. J Nucl Med 2011;52:1048-55.
Horn KP, Yap JT, Agarwal N, Morton KA, Kadrmas DJ, Beardmore B, et al.
FDG and FLT-PET for early measurement of response to 37.5 mg daily sunitinib therapy in metastatic renal cell carcinoma. Cancer Imaging 2015;15:15.
Oyama N, Takahara N, Hasegawa Y, Tanase K, Miwa Y, Akino H, et al.
Assessment of therapeutic effect of sunitinib by (11) C-acetate PET compared with FDG PET imaging in a patient with metastatic renal cell carcinoma. Nucl Med Mol Imaging 2011;45:217-9.
Middendorp M, Maute L, Sauter B, Vogl TJ, Grünwald F. Initial experience with 18F-fluoroethylcholine PET/CT in staging and monitoring therapy response of advanced renal cell carcinoma. Ann Nucl Med 2010;24:441-6.
Siva S, Callahan J, Pryor D, Martin J, Lawrentschuk N, Hofman MS, et al.
Utility of 68
ga prostate specific membrane antigen – Positron emission tomography in diagnosis and response assessment of recurrent renal cell carcinoma. J Med Imaging Radiat Oncol 2017;61:372-8.
Antunes J, Viswanath S, Rusu M, Valls L, Hoimes C, Avril N, et al.
Radiomics analysis on FLT-PET/MRI for characterization of early treatment response in renal cell carcinoma: A Proof-of-concept study. Transl Oncol 2016;9:155-62.
Stillebroer AB, Mulders PF, Boerman OC, Oyen WJ, Oosterwijk E. Carbonic anhydrase IX in renal cell carcinoma: Implications for prognosis, diagnosis, and therapy. Eur Urol 2010;58:75-83.
Divgi CR, Uzzo RG, Gatsonis C, Bartz R, Treutner S, Yu JQ, et al.
Positron emission tomography/computed tomography identification of clear cell renal cell carcinoma: Results from the REDECT trial. J Clin Oncol 2013;31:187-94.
Metser U, Miller E, Lerman H, Lievshitz G, Avital S, Even-Sapir E, et al.
18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med 2006;47:32-7.
Caoili EM, Korobkin M, Brown RK, Mackie G, Shulkin BL. Differentiating adrenal adenomas from nonadenomas using (18) F-FDG PET/CT: Quantitative and qualitative evaluation. Acad Radiol 2007;14:468-75.
Boland GW, Dwamena BA, Jagtiani Sangwaiya M, Goehler AG, Blake MA, Hahn PF, et al.
Characterization of adrenal masses by using FDG PET: A systematic review and meta-analysis of diagnostic test performance. Radiology 2011;259:117-26.
Nunes ML, Rault A, Teynie J, Valli N, Guyot M, Gaye D, et al.
18F-FDG PET for the identification of adrenocortical carcinomas among indeterminate adrenal tumors at computed tomography scanning. World J Surg 2010;34:1506-10.
Boland GW, Blake MA, Holalkere NS, Hahn PF. PET/CT for the characterization of adrenal masses in patients with cancer: Qualitative versus quantitative accuracy in 150 consecutive patients. AJR Am J Roentgenol 2009;192:956-62.
Park SY, Park BK, Kim CK. The value of adding (18) F-FDG PET/CT to adrenal protocol CT for characterizing adrenal metastasis (≥10 mm) in oncologic patients. AJR Am J Roentgenol 2014;202:W153-60.
Brady MJ, Thomas J, Wong TZ, Franklin KM, Ho LM, Paulson EK, et al.
Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer: A proposal for an efficient diagnostic algorithm. Radiology 2009;250:523-30.
Cistaro A, Niccoli Asabella A, Coppolino P, Quartuccio N, Altini C, Cucinotta M, et al.
Diagnostic and prognostic value of 18F-FDG PET/CT in comparison with morphological imaging in primary adrenal gland malignancies – A multicenter experience. Hell J Nucl Med 2015;18:97-102.
Becherer A, Vierhapper H, Pötzi C, Karanikas G, Kurtaran A, Schmaljohann J, et al.
FDG-PET in adrenocortical carcinoma. Cancer Biother Radiopharm 2001;16:289-95.
Leboulleux S, Dromain C, Bonniaud G, Aupérin A, Caillou B, Lumbroso J, et al.
Diagnostic and prognostic value of 18-fluorodeoxyglucose positron emission tomography in adrenocortical carcinoma: A prospective comparison with computed tomography. J Clin Endocrinol Metab 2006;91:920-5.
Blake MA, Prakash P, Cronin CG. PET/CT for adrenal assessment. AJR Am J Roentgenol 2010;195:W91-5.
Shulkin BL, Thompson NW, Shapiro B, Francis IR, Sisson JC. Pheochromocytomas: Imaging with 2-[fluorine-18]fluoro-2-deoxy-D-glucose PET. Radiology 1999;212:35-41.
Timmers HJ, Chen CC, Carrasquillo JA, Whatley M, Ling A, Eisenhofer G, et al.
Staging and functional characterization of pheochromocytoma and paraganglioma by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography. J Natl Cancer Inst 2012;104:700-8.
Takeuchi S, Balachandran A, Habra MA, Phan AT, Bassett RL Jr., Macapinlac HA, et al.
Impact of 1
F-FDG PET/CT on the management of adrenocortical carcinoma: Analysis of 106 patients. Eur J Nucl Med Mol Imaging 2014;41:2066-73.
Ardito A, Massaglia C, Pelosi E, Zaggia B, Basile V, Brambilla R, et al.
18F-FDG PET/CT in the post-operative monitoring of patients with adrenocortical carcinoma. Eur J Endocrinol 2015;173:749-56.
Patil VV, Wang ZJ, Sollitto RA, Chuang KW, Konety BR, Hawkins RA, et al.
18F-FDG PET/CT of transitional cell carcinoma. AJR Am J Roentgenol 2009;193:W497-504.
Asai S, Fukumoto T, Tanji N, Miura N, Miyagawa M, Nishimura K, et al.
Fluorodeoxyglucose positron emission tomography/computed tomography for diagnosis of upper urinary tract urothelial carcinoma. Int J Clin Oncol 2015;20:1042-7.
Tanaka H, Yoshida S, Komai Y, Sakai Y, Urakami S, Yuasa T, et al.
Clinical value of 18F-fluorodeoxyglucose positron emission tomography/Computed tomography in upper tract urothelial carcinoma: Impact on detection of metastases and patient management. Urol Int 2016;96:65-72.
Giannatempo P, Alessi A, Miceli R, Raggi D, Farè E, Nicolai N, et al.
Interim fluorine-18 fluorodeoxyglucose positron emission tomography for early metabolic assessment of therapeutic response to chemotherapy for metastatic transitional cell carcinoma. Clin Genitourin Cancer 2014;12:433-9.
Kitajima K, Yamamoto S, Fukushima K, Yamakado K, Katsuura T, Igarashi Y, et al.
FDG-PET/CT as a post-treatment restaging tool in urothelial carcinoma: Comparison with contrast-enhanced CT. Eur J Radiol 2016;85:593-8.
Wang N, Jiang P, Lu Y. Is fluorine-18 fluorodeoxyglucose positron emission tomography useful for detecting bladder lesions? A meta-analysis of the literature. Urol Int 2014;92:143-9.
Lodde M, Lacombe L, Friede J, Morin F, Saourine A, Fradet Y, et al.
Evaluation of fluorodeoxyglucose positron-emission tomography with computed tomography for staging of urothelial carcinoma. BJU Int 2010;106:658-63.
Anjos DA, Etchebehere EC, Ramos CD, Santos AO, Albertotti C, Camargo EE, et al.
18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer. J Nucl Med 2007;48:764-70.
Harkirat S, Anand S, Jacob M. Forced diuresis and dual-phase F-fluorodeoxyglucose-PET/CT scan for restaging of urinary bladder cancers. Indian J Radiol Imaging 2010;20:13-9.
] [Full text]
Nayak B, Dogra PN, Naswa N, Kumar R. Diuretic 18F-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;40:386-93.
Lu YY, Chen JH, Liang JA, Wang HY, Lin CC, Lin WY, et al.
Clinical value of FDG PET or PET/CT in urinary bladder cancer: A systemic review and meta-analysis. Eur J Radiol 2012;81:2411-6.
Mertens LS, Fioole-Bruining A, Vegt E, Vogel WV, van Rhijn BW, Horenblas S, et al.
Impact of (18) F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) on management of patients with carcinoma invading bladder muscle. BJU Int 2013;112:729-34.
Kollberg P, Almquist H, Bläckberg M, Cronberg C, Garpered S, Gudjonsson S, et al.
[(18)F] Fluorodeoxyglucose – Positron emission tomography/computed tomography improves staging in patients with high-risk muscle-invasive bladder cancer scheduled for radical cystectomy. Scand J Urol 2015;49:296-301.
Apolo AB, Riches J, Schöder H, Akin O, Trout A, Milowsky MI, et al.
Clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in bladder cancer. J Clin Oncol 2010;28:3973-8.
Kibel AS, Dehdashti F, Katz MD, Klim AP, Grubb RL, Humphrey PA, et al.
Prospective study of [18F] fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol 2009;27:4314-20.
Mertens LS, Mir MC, Scott AM, Lee ST, Fioole-Bruining A, Vegt E, et al.
18F-fluorodeoxyglucose – Positron emission tomography/computed tomography aids staging and predicts mortality in patients with muscle-invasive bladder cancer. Urology 2014;83:393-8.
Mertens LS, Fioole-Bruining A, van Rhijn BW, Kerst JM, Bergman AM, Vogel WV, et al.
FDG-positron emission tomography/computerized tomography for monitoring the response of pelvic lymph node metastasis to neoadjuvant chemotherapy for bladder cancer. J Urol 2013;189:1687-91.
Öztürk H, Karapolat I. Efficacy of 18
F-fluorodeoxyglucose-positron emission tomography/computed tomography in restaging muscle-invasive bladder cancer following radical cystectomy. Exp Ther Med 2015;9:717-24.
Gofrit ON, Mishani E, Orevi M, Klein M, Freedman N, Pode D, et al.
Contribution of 11C-choline positron emission tomography/computerized tomography to preoperative staging of advanced transitional cell carcinoma. J Urol 2006;176:940-4.
Picchio M, Treiber U, Beer AJ, Metz S, Bössner P, van Randenborgh H, et al.
Value of 11C-choline PET and contrast-enhanced CT for staging of bladder cancer: Correlation with histopathologic findings. J Nucl Med 2006;47:938-44.
Golan S, Sopov V, Baniel J, Groshar D. Comparison of 11C-choline with 18F-FDG in positron emission tomography/computerized tomography for staging urothelial carcinoma: A prospective study. J Urol 2011;186:436-41.
Maurer T, Souvatzoglou M, Kübler H, Opercan K, Schmidt S, Herrmann K, et al.
Diagnostic efficacy of [11C] choline positron emission tomography/computed tomography compared with conventional computed tomography in lymph node staging of patients with bladder cancer prior to radical cystectomy. Eur Urol 2012;61:1031-8.
Ahlström H, Malmström PU, Letocha H, Andersson J, Långström B, Nilsson S, et al.
Positron emission tomography in the diagnosis and staging of urinary bladder cancer. Acta Radiol 1996;37:180-5.
Schöder H, Ong SC, Reuter VE, Cai S, Burnazi E, Dalbagni G, et al.
Initial results with (11) C-acetate positron emission tomography/computed tomography (PET/CT) in the staging of urinary bladder cancer. Mol Imaging Biol 2012;14:245-51.
Civelek AC, Apolo A, Agarwal P, Evers R, Bluemke D, Malayeri A. 18F-FDG PET-MRI in the management of muscle invasive bladder cancer: Challenges in imaging and solutions. J Nucl Med 2016;57 Suppl 2:1292.
Civelek A, Lin J, Agarwal P, Malayeri A, Apolo A. FDG PET-MRI in the management of patients with muscle invasive bladder cancer. J Nucl Med 2017;58 Suppl 1:753.
Treglia G, Sadeghi R, Annunziata S, Caldarella C, Bertagna F, Giovanella L, et al.
Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography in the postchemotherapy management of patients with seminoma: Systematic review and meta-analysis. Biomed Res Int 2014;2014:852681.
Bachner M, Loriot Y, Gross-Goupil M, Zucali PA, Horwich A, Germa-Lluch JR, et al
fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) for postchemotherapy seminoma residual lesions: A retrospective validation of the SEMPET trial. Ann Oncol 2012;23:59-64.
Hinz S, Schrader M, Kempkensteffen C, Bares R, Brenner W, Krege S, et al.
The role of positron emission tomography in the evaluation of residual masses after chemotherapy for advanced stage seminoma. J Urol 2008;179:936-40.
Müller J, Schrader AJ, Jentzmik F, Schrader M. Assessment of residual tumours after systemic treatment of metastatic seminoma:18
F-2-fluoro-2-deoxy-D-glucose positron emission tomography – Meta-analysis of diagnostic value. Urologe A 2011;50:322-7.
Oechsle K, Hartmann M, Brenner W, Venz S, Weissbach L, Franzius C, et al.
[18F]Fluorodeoxyglucose positron emission tomography in nonseminomatous germ cell tumors after chemotherapy: The German multicenter positron emission tomography study group. J Clin Oncol 2008;26:5930-5.
Scher B, Seitz M, Reiser M, Hungerhuber E, Hahn K, Tiling R, et al.
18F-FDG PET/CT for staging of penile cancer. J Nucl Med 2005;46:1460-5.
Leijte JA, Graafland NM, Valdés Olmos RA, van Boven HH, Hoefnagel CA, Horenblas S, et al.
Prospective evaluation of hybrid 18F-fluorodeoxyglucose positron emission tomography/computed tomography in staging clinically node-negative patients with penile carcinoma. BJU Int 2009;104:640-4.
Souillac I, Rigaud J, Ansquer C, Marconnet L, Bouchot O. Prospective evaluation of (18)F-fluorodeoxyglucose positron emission tomography-computerized tomography to assess inguinal lymph node status in invasive squamous cell carcinoma of the penis. J Urol 2012;187:493-7.
Sadeghi R, Gholami H, Zakavi SR, Kakhki VR, Horenblas S. Accuracy of 18F-FDG PET/CT for diagnosing inguinal lymph node involvement in penile squamous cell carcinoma: Systematic review and meta-analysis of the literature. Clin Nucl Med 2012;37:436-41.
Zhang S, Li W, Liang F. Clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in penile cancer. Oncotarget 2016;7:48600-6.