title: Impact of 18F-FDG PET/CT with retrograde filling of the urinary bladder in patients with suspected pelvic malignancies.
abstract: The purpose of this study was to assess the feasibility of selective pelvic PET/CT with retrograde bladder irrigation in evaluating pelvic pathologies.
  
  
  METHODS
  Thirty-eight patients (22 women and 16 men), with a mean age of 61 y (range, 41-81 y) and a neoplastic background (most of them of pelvic pathology), were assessed with PET/CT. The most prevalent findings were urothelial (14 cases), gynecologic (12 cases), and rectal (7 cases) cancers. All but 3 patients had undergone previous surgical procedures or radio- or chemotherapy. Twenty-two patients had suspected pelvic pathology on a previous diagnostic CT scan. All the patients underwent a standard PET/CT protocol (from head to upper thighs) 60 min after the intravenous injection of 370 MBq of (18)F-FDG. Additional delayed pelvic PET/CT images were acquired with a filled-bladder technique. Both series of images were assessed by 2 experienced observers. A lesion was classified as malignant if it showed a standardized uptake value greater than 2.5 or, in the case of subcentimetric lesions, any uptake greater than background activity that persisted or increased on delayed pelvic imaging. All lesions were evaluated histologically or by clinical follow-up.
  
  
  RESULTS
  Twenty-seven of 43 studies were categorized as pathologic using PET/CT. Nineteen studies showed abnormalities in the pelvis; the findings of 5 of these studies were false-positive. Ten studies showed pathologic (18)F-FDG uptake in the bladder wall; in 7 of these studies the uptake was found to be true-positive on histopathologic examination. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT in the pelvic assessment were 100%, 83%, 74%, 100%, and 76%, respectively. The retrograde filling reduced the interference with physiologic urinary accumulation of (18)F-FDG in patients with possible pelvic lesions; no false-negative results were documented.
  
  
  CONCLUSIONS
  In (18)F-FDG PET studies, retrograde filling of the urinary bladder is recommended to assess bladder wall lesions and malignancies in other pelvic locations.
authors.affiliation: Nuclear Medicine Department, General University Hospital, Ciudad Real, Spain. angarvice@yahoo.es
authors.forename: Ana Maria Garcia
authors.initials: AM
authors.lastname: Vicente
authors.forename: Angel Soriano
authors.initials: AS
authors.lastname: Castrejón
authors.forename: Azahara Palomar
authors.initials: AP
authors.lastname: Muñoz
authors.forename: Patrick Pilkington
authors.initials: PP
authors.lastname: Woll
authors.forename: Alicia Nuñez
authors.initials: AN
authors.lastname: García
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed / Q000379:methods*; D001743:Urinary Bladder
chemical_list: D019788:Fluorodeoxyglucose F18