title: FDG PET/CT in detection of adrenal metastasis in patients with renal cell carcinoma.
abstract: OBJECTIVE
  Adrenal metastasis in renal cell carcinoma (RCC) is uncommon. The present study was aimed to evaluate the role of fluoro-deoxy-glucose positron emission tomography (FDG PET)/computed tomography (CT) in the detection of adrenal metastasis in patients with RCC.
  
  
  METHODS
  A total of 9 FDG PET/CT scans were performed in 4 patients (3 males, 1 female; median age: 53.5 years, range: 52-73 years). Of 9 PET/CT scans, 2 scans were done for initial staging, 2 for restaging, and 5 for evaluation of treatment response. PET/CT image interpretation and analysis was performed qualitatively (visually) and semiquantitatively. Absence of uptake in postchemotherapy PET/CT scan was considered as complete response and a fall in SUV by more than 50% of baseline value, as significant response.
  
  
  RESULTS
  Patients 1 and 2 underwent staging FDG PET/CT. Patient 1 had undergone left radical nephrectomy 13 years back for left-sided RCC. Current FDG PET/CT revealed appearance of right RCC with adrenal metastasis. PET/CT of patient 2 demonstrated right adrenal and distant metastases. PET/CT done for restaging in patient 3, revealed right adrenal and abdominal lymph nodal metastasis. In patient 4, PET/CT revealed solitary adrenal metastasis. Magnetic resonance imaging findings were consistent with adrenal metastasis in this patient. Patient 1 received sunitinib and interferon chemotherapy along with radiotherapy and showed partial response on PET/CT scans done at 6, 17, 23, and 33 months from the initial study. PET/CT of patient 3 demonstrated the progression of disease (nonresponder).
  
  
  CONCLUSIONS
  FDG PET/CT appears to be useful for staging, treatment response evaluation, and recurrence detection in patients with RCC having adrenal metastasis.
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India. rkphulia@yahoo.com
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Shamim Ahmed
authors.initials: SA
authors.lastname: Shamim
authors.forename: Varun
authors.initials: V
authors.lastname: Shandal
authors.forename: Punit
authors.initials: P
authors.lastname: Sharma
authors.forename: Ankur
authors.initials: A
authors.lastname: Gadodia
authors.forename: Arun
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18