title: Evaluation of 2 diuretic 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography imaging protocols for intrapelvic cancer.
abstract: BACKGROUND
  18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) plays an important part in the oncological evaluation of the abdomen and pelvis, but the interpretation and quantification is often hampered by intense physiological urinary activity. We evaluate 2 different diuretic imaging protocols by comparing intensity of urinary activity and we look at the impact of multiple variables on the final urinary activity.
  
  
  METHODS
  Comparative analysis of 102 patients (median age: 64) having intrapelvic carcinoma. After full body acquisition, 58 patients were administered 20 mg of furosemide 90 min post injection of FDG (P90). For 44 patients, 20 mg of furosemide was administered 30 min post injection of FDG (P30). Comparisons between groups were performed using the Mann-Whitney Test and χ2. The BMI, creatinine, clearance, age, injected activity, diuretic protocol, gender and glycemia were evaluated with multivariate analysis for their impact on the final urinary activity.
  
  
  RESULTS
  Concerning the comparison of the urinary activity we observe a significant difference (P=0.0029) between P90 and P30 for the SUVmax (median 4.3 [range 1.6: 17.7] vs. 6.0 [range 2.9: 15.1]), and for the SUVmean (P<0.001) (median 2.4 [range 1.1; 9.9] vs. 3.8 [range 2.0; 10.1]). For 2 patients of P30, the acquisition was interrupted because the patient needed to void. Multivariate analysis shows that creatinine and creatinine clearance do not have a significant independent impact on the final bladder activity.
  
  
  CONCLUSIONS
  By comparing the 2 diuretic imaging protocols, we found a significant lower urinary activity for the P90 protocol and the regression decision tree shows that the P90 protocol is mostly superior. The P30 protocol, which seems to be less well tolerated, is adequate in the group of patients with an injected activity of less than 240 MBq and older than 65 years, if P90 is not feasible. For most patients with injected activity ≥240 MBq or BMI of ≥25 and a glycemia >120 mg/dL, a significant amount of residual urinary activity remains for both protocols.
authors.affiliation: Department of Nuclear Medicine, Institut Universitaire Cancer Toulouse Oncopole, Toulouse, France - dierickxlawrence@hotmail.com.|Laboratoire de Recherche LU50 SIMAD, Paul Sabatier Toulouse III University, Toulouse, France - dierickxlawrence@hotmail.com.
authors.forename: Lawrence O
authors.initials: LO
authors.lastname: Dierickx
authors.affiliation: Department of Nuclear Medicine, Institut Universitaire Cancer Toulouse Oncopole, Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Dercle
authors.affiliation: Department of Nuclear Medicine, Institut Universitaire Cancer Toulouse Oncopole, Toulouse, France.
authors.forename: Leonor
authors.initials: L
authors.lastname: Chaltiel
authors.affiliation: Department of Nuclear Medicine, Institut Universitaire Cancer Toulouse Oncopole, Toulouse, France.|Laboratoire de Recherche LU50 SIMAD, Paul Sabatier Toulouse III University, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Caselles
authors.affiliation: Department of Nuclear Medicine, Institut Universitaire Cancer Toulouse Oncopole, Toulouse, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Brillouet
authors.affiliation: Department of Nuclear Medicine, Institut Universitaire Cancer Toulouse Oncopole, Toulouse, France.
authors.forename: Slimane
authors.initials: S
authors.lastname: Zerdoud
authors.affiliation: Department of Nuclear Medicine, Institut Universitaire Cancer Toulouse Oncopole, Toulouse, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Courbon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000494:pharmacology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005665:Furosemide / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000000981:diagnostic imaging*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D055815:Young Adult
chemical_list: D004232:Diuretics; D019788:Fluorodeoxyglucose F18; D005665:Furosemide