title: Defining the Added Value of 99mTc-MIBI SPECT/CT to Conventional Cross-Sectional Imaging in the Characterization of Enhancing Solid Renal Masses.
abstract: OBJECTIVE
  This study investigates whether the addition of preoperative Tc-MIBI SPECT/CT can increase the degree of diagnostic confidence in the differentiation of benign from malignant enhancing renal masses.
  
  
  METHODS
  Patients were recruited as part of an institutional review board-approved prospective clinical trial. Forty-eight patients with clinical stage T1 solid renal masses who underwent a Tc-MIBI SPECT/CT before partial or radical nephrectomy were evaluated. Conventional CT and MRI, which were approximately performed within 8 weeks before Tc-MIBI, were retrospectively retrieved. Based on a 5-point scale (1 = definitely benign, 5 = definitely malignant), 2 blinded readers recorded their degree of confidence for each lesion using conventional imaging before and after reviewing the Tc-MIBI uptake ratios. Surgical pathology was considered as the reference standard.
  
  
  RESULTS
  Additional review of Tc-MIBI SPECT/CT uptake ratios increased diagnostic confidence in the differentiation of solid renal masses in 14/48 lesions (29.2%). In 9 lesions, the addition of Tc-MIBI changed the initial confidence levels of malignancy toward benign diagnosis. Postsurgical pathology confirmed the diagnosis of benign histology (oncocytoma/hybrid oncocytic-chromophobe tumors) in 7 and chromophobe renal cell carcinoma (behave as indolent) in 2 of these lesions. Tc-MIBI increased the confidence level toward malignancy in 5 cases; all were confirmed as RCC on surgical pathology. The area under the receiver operative characteristic curve was 0.60 for conventional imaging alone and 0.85 after reviewing Tc-MIBI (P for difference = 0.03).
  
  
  CONCLUSIONS
  Preoperative Tc-MIBI SPECT/CT enhances the performance of conventional imaging, improving the characterization of benign histologies and lowering the possibility of misclassification.
authors.affiliation: From the *The Russell H. Morgan Department of Radiology and Radiological Science, †The James Buchanan Brady Urological Institute and Department of Urology, and ‡Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; and §Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.
authors.forename: Sara
authors.initials: S
authors.lastname: Sheikhbahaei
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Jones
authors.forename: Kristin K
authors.initials: KK
authors.lastname: Porter
authors.forename: Steven P
authors.initials: SP
authors.lastname: Rowe
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.forename: Alex S
authors.initials: AS
authors.lastname: Baras
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ball
authors.forename: Takahiro
authors.initials: T
authors.lastname: Higuchi
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Johnson
authors.forename: Lilja B
authors.initials: LB
authors.lastname: Solnes
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
authors.forename: Mehrbod S
authors.initials: MS
authors.lastname: Javadi
mesh_terms: D018249:Adenoma, Oxyphilic / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi