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Furosemide diminishes 18F-fluoroethylcholine uptake in prostate cancer in vivo

  • Original Article
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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

18F-Fluoroethylcholine (18F-FECh) is excreted via the urinary system with high activity accumulation in the urinary bladder. Furosemide and oral hydration can be administered concomitantly to reduce urinary activity to provide better detectability of retroperitoneal and pelvic lesions. Currently it is unknown if there is any effect of furosemide on 18F-FECh uptake in organs, tissues and tumour lesions and the extent to which image quality along the urinary tract may be improved by furosemide.

Methods

We retrospectively analysed 217 18F-FECh PET/CT examinations from 213 patients with known prostate cancer (PCa), performed either with oral hydration (109) or furosemide 20 mg together with oral hydration (108). Maximum 18F-FECh uptake in different organs, tissues, lymph nodes and osseous metastases was quantified in terms of standardized uptake value (SUV) in a volume of interest and compared between the two groups. To characterize the impact of furosemide on lesion detectability a three-point rating scale was used to assess the presence of focal activity spots in the ureters and of perivesicular artefacts.

Results

Patient characteristics and distribution of tumour lesions were well balanced between the two groups. Overall, SUVmax values from normal organs were increased after furosemide compared to the values in patients scanned without furosemide. Significant changes were observed in the salivary glands, liver, spleen, pancreas, kidneys, gluteus muscle and perirenal fat. SUVmax values were significantly decreased after furosemide in lymph node metastases (SUVmax 4.81 ± 2.68 vs. 6.48 ± 4.22, p = 0.0006), but not in osseous metastases. Evaluation of image quality along the urinary tract revealed significantly better depiction of the perivesicular space and significantly less focal tracer accumulation in the ureters in patients receiving furosemide, but the number of detected lymph nodes was not significantly different.

Conclusion

Furosemide administration reduced choline uptake in tumour lesions, especially significant in pelvic lymph node metastases. Although furosemide administration improved image quality, optimal image quality may also be obtained by adequate hydration without the risk of diminishing choline uptake in PCa lesions. Therefore a controlled hydration protocol seems more appropriate than administration of furosemide.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Freiburg, Hugstetterstr 55, 79106, Freiburg, Germany

    H. Christian Rischke & Anca L. Grosu

  2. Department of Nuclear Medicine, University of Freiburg, Freiburg, Germany

    H. Christian Rischke, Teresa Beck, Gesche Wieser & Philipp T. Meyer

  3. Department of Clinical Epidemiology, Department of Medical Biometry and Medical Informatics, University of Freiburg, Freiburg, Germany

    Werner Vach

  4. Department of Urology, University of Freiburg, Freiburg, Germany

    Wolfgang Schultze-Seemann & Cordula A. Jilg

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  1. H. Christian Rischke
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Correspondence to H. Christian Rischke.

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H. Christian Rischke and Teresa Beck contributed equally to this work.

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Rischke, H.C., Beck, T., Vach, W. et al. Furosemide diminishes 18F-fluoroethylcholine uptake in prostate cancer in vivo. Eur J Nucl Med Mol Imaging 41, 2074–2082 (2014). https://doi.org/10.1007/s00259-014-2829-0

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