Positron emission tomography as a tool for the 'tailored' management of retroperitoneal fibrosis: a nephro-urological experience.
BACKGROUND
Retroperitoneal fibrosis (RF) is a complex clinical entity characterized by a fibro-inflammatory reaction around the abdominal aorta and iliac arteries extended into the retroperitoneum. No biochemical marker correlates with the disease severity and progression, and imaging data fail to discriminate between fibrotic and florid lesions. Positron emission tomography (PET) was recently suggested as a promising tool to detect the disease.


METHODS
We report on seven consecutive cases of RF managed by tailoring therapeutic interventions to the metabolic activity detected by PET. In 2006-09, seven patients with RF (five new diagnoses) were referred to the same nephro-urological facility. There were six males and one female aged 41-79. RF was associated with autoimmune diseases in three patients, with an aortic aneurysm in another three, and was 'idiopathic' in one. The diagnoses were made by imaging techniques [computed tomography (CT) or nuclear magnetic resonance (NMR)]; PET scan was performed in all patients in the same setting at referral and during follow-up.


RESULTS
Patients were followed up with tailored interventions (medical therapy: tamoxifen, steroids, and immunosuppressors according to disease activity, side effects and tolerance). Six patients needed ureteral stenting for obstruction. PET imaging was used as a guide for the tapering of immunosuppressors and for stent removal. In this way, stents were safely removed when a negativization of disease activity was revealed by PET. Only one relapse was recorded over 163 months of follow-up (median 24 months) detected in time by PET.


CONCLUSIONS
PET is a promising tool for surveillance of disease activity and for planning the removal of ureteral stents in RF.
Urology and Nephrology, San Luigi Gonzaga University Hospital, Regione Gonzole 10, Orbassano Torino, Turin, Italy. gbpiccoli@yahoo.it
Giorgina Barbara
GB
Piccoli
Valentina
V
Consiglio
Vincenzo
V
Arena
Ettore
E
Pelosi
Douroukas
D
Anastasios
Francesca
F
Ragni
Cristian
C
Fiori
Gianfranco
G
Cortese
Maria Chiara
MC
Deagostini
Francesco
F
Porpiglia
Roberto Mario
RM
Scarpa
D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000150:complications; D001327:Autoimmune Diseases / Q000150:complications; D020878:Device Removal; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012185:Retroperitoneal Fibrosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D013256:Steroids / Q000627:therapeutic use; D013629:Tamoxifen / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D013256:Steroids; D013629:Tamoxifen