Forced diuresis improves the diagnostic accuracy of 18F-FDG PET in abdominopelvic malignancies.
Our aim was to evaluate the role of forced diuresis in improving the diagnostic accuracy of abdominopelvic (18)F-FDG PET.


METHODS
Thirty-two patients were enrolled. Besides the presence of known intravesical tumors or undefined renal lesions on the initial PET scan, the inclusion criterion was the appearance of indeterminate or equivocal (18)F-FDG foci that extended along the course of the urinary tract and could not confidently be separated from urinary activity. For each patient, a second abdominopelvic PET study was performed after intravenous injection of 0.5 mg of furosemide per kilogram of body weight (maximum, 40 mg) coupled with parenteral infusion of physiologic saline.


RESULTS
Forced diuresis coupled with parenteral hydration eliminated any significant (18)F-FDG activity from the lower urinary tract in 31 (97%) of 32 patients after the bladder had been voided 3 successive times. Twelve intravesical lesions were visualized with outstanding clarity, whereas radiologic suspicion of locally recurrent bladder tumors was ruled out in 3 patients. Among 14 indeterminate or equivocal extravesical foci, 7 were deemed of no clinical value because they disappeared after furosemide challenge, whereas 7 persisting foci were proven to be true-positive PET findings. The performance of (18)F-FDG PET in characterizing 3 renal-space-occupying lesions could not be improved by our protocol.


CONCLUSIONS
Furosemide challenge has the potential to noninvasively resolve the inherent (18)F-FDG contrast handicap in the lower urinary tract.
Kamel
Ehab M
EM
Department of Nuclear Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Mohamed-Ehab.Kamel@chuv.ch
Jichlinski
Patrice
P
Prior
John O
JO
Meuwly
Jean-Yves
JY
Delaloye
Jean-Francois
JF
Vaucher
Laurent
L
Malterre
Jerome
J
Castaldo
Sandra
S
Leisinger
Hans-Juerg
HJ
Delaloye
Angelika Bischof
AB
D000328:Adult; D004231:Diuresis; D005260:Female; D019788:Fluorodeoxyglucose F18; D005665:Furosemide / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010386:Pelvic Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000532:radiotherapy; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005665:Furosemide