title: Detecting primary bladder cancer using delayed (18)F-2-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography imaging after forced diuresis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the use of delayed pelvic (18)F-2-fluoro-2-deoxy-D-glucose-positron emission tomography combined with the computed tomography (FDG-PET/CT) imaging, according to a standardized protocol including, pre-hydration and forced diuresis, for the detection of primary bladder cancer.
  
  
  METHODS
  We evaluated 38 consecutive patients with primary cT1-4 bladder cancer. They underwent standard FDG-PET/CT followed by delayed pelvic imaging after administration of 20 mg furosemide intravenously and extra oral water intake of 0.5 L. Two observers, blinded for patient data, scored both image sets for tumor visibility using a 3-point ordinal scale: (1) negative; (2) indeterminate; (3) positive. FDG-PET/CT findings were compared with histopathology and/or follow-up imaging.
  
  
  RESULTS
  The procedure was completed successfully in 37/38 patients and the reference standard revealed a bladder tumor in 26/37 patients. Delayed PET/CT images showed reduction of urinary bladder activity to (near) background levels in 17 of 37 cases (45.9%). Standard PET/CT detected hyper-metabolic bladder lesions in 15/37 patients (40.5%) of which 8 were indeterminate. Delayed FDG-PET/CT showed hyper-metabolic bladder lesions in 30/37 (81.1%) patients, of which 5 were indeterminate. When indeterminate lesions were considered positive, the sensitivity of standard and delayed PET/CT was 46% versus 88%, respectively. The specificity was 72% versus 36%. When indeterminate lesions were considered negative, the sensitivity of standard and delayed PET/CT was 23% and 85%. The specificity was 93% versus 73%.
  
  
  CONCLUSIONS
  Our data suggest that delayed pelvic FDG-PET/CT imaging after forced detects more primary bladder tumors than standard FDG-PET/CT protocols. However, indeterminate bladder lesions on delayed PET/CT remain a problem and should be interpreted cautiously in order to avoid false positive results.
authors.affiliation: Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Mertens
authors.forename: Annemarie
authors.initials: A
authors.lastname: Fioole-Bruining
authors.forename: Erik
authors.initials: E
authors.lastname: Vegt
authors.forename: Wouter V
authors.initials: WV
authors.lastname: Vogel
authors.forename: Bas Wg
authors.initials: BW
authors.lastname: van Rhijn
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
keywords: Diagnostic imaging; fluorodeoxyglucose F18; positron emission tomography and computed tomography; urinary bladder neoplasms
references.citation: J Nucl Med. 2006 Nov;47(11):1803-7
references.pmid: 17079813
references.citation: Eur J Radiol. 2012 Sep;81(9):2411-6
references.pmid: 21899971
references.citation: Eur J Nucl Med. 1997 Jun;24(6):615-20
references.pmid: 9169567
references.citation: Nucl Med Commun. 2010 Feb;31(2):167-72
references.pmid: 19997041
references.citation: J Nucl Med Technol. 2011 Jun;39(2):77-82
references.pmid: 21565956
references.citation: Indian J Radiol Imaging. 2010 Feb;20(1):13-9
references.pmid: 20351986
references.citation: J Urol. 1991 Feb;145(2):279-83
references.pmid: 1988718
references.citation: J Nucl Med. 2007 May;48(5):764-70
references.pmid: 17475965
references.citation: Nucl Med Commun. 2012 Nov;33(11):1195-201
references.pmid: 22781846
references.citation: J Nucl Med Technol. 2010 Sep;38(3):128-37
references.pmid: 20807854
references.citation: J Clin Oncol. 2010 Sep 1;28(25):3973-8
references.pmid: 20679618
references.citation: J Clin Oncol. 2009 Sep 10;27(26):4314-20
references.pmid: 19652070
references.citation: Ann Nucl Med. 2012 Aug;26(7):571-7
references.pmid: 22763630
references.citation: Eur Urol. 2002 May;41(5):523-31
references.pmid: 12074794
references.citation: J Nucl Med. 2003 Mar;44(3):353-8
references.pmid: 12621000
references.citation: J Nucl Med Technol. 1997 Jun;25(2):115-9
references.pmid: 9239615