Clinical Utility of 18F-FDG PET/CT Scanning in Urological Cancers Management
Positron emission tomography/computed tomography (PET/CT) has become an important method for the diagnosis/identification, staging, follow-up monitoring, and efficacy and prognosis determination of malignant tumors. The glucose analog 18F-deoxyglucose (FDG) is the most mature and widely used imaging agent for PET. Since most malignant cells show a high glucose metabolism, they can accumulate more 18F-FDG than do normal tissues and organs, which can be detected by PET/CT and distinguished from normal tissues. 18F-FDG-PET/CT imaging has good sensitivity and accuracy for the diagnosis and evaluation of most malignant tumors. However, 18F-FDG-PET/CT has limited application in primary urinary tumors (prostate cancer, renal clear-cell carcinoma, and bladder cancer [BC]). Initial studies evaluating the role of 18F-FDG-PET in kidney and bladder malignancies showed disappointingly low sensitivity. The main reason is that FDG is mainly excreted through the urinary system, thereby masking the FDG uptake of primary renal and BCs. Many researchers are trying to improve the sensitivity and specificity of PET/CT in urological malignancies through a variety of techniques, including bladder irrigation and delayed imaging. Recent studies using PET/CT instead of PET and some improved protocol techniques have shown better sensitivity and specificity, and PET/CT now appears to be more useful in the staging and follow-up of urinary malignancies than originally reported.
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