Assessment of the diagnostic performance of 18F-FDG-PET/CT for detection and characterization of solid renal malignancies

To evaluate the sensitivity of the positron emission tomography (PET) portion of fluorine-18 fluoro-deoxyglucose-PET-computerized tomography (F-18-FDG-PET/CT) to detect solid malignant renal masses, and to assess for Metabolic differences based on histopathological type. Nineteen subjects with 25 known solid malignant renal masses who underwent F-18-FDG-PET/CT were retrospectively evaluated. Qualitative analysis of the PET portion only of F-18-FDG-PET/CT examinations to assess visual detection of renal masses was initially performed in blinded fashion. Subsequently, measurements of standardized uptake value (SUV) and lesion-to-background ratios were performed for all masses and compared between histopathological types. Of 25 solid malignant renal masses, 18 were renal cell carcinoma (RCC), 3 were renal lymphoma, and 4 were metastases. Twenty-two of 25 were detectable, and all were correctly spatially localized. Fifteen of 22 detectable lesions were exophytic in configuration. The three non-detectable masses were non-exophytic RCC's with average diameter of 2.0cm. Fifteen of 18 of RCC were detectable, whereas all renal lymphomas and metastases were detectable. None of the metabolic parameters were statistically significant between RCC and renal lymphoma. However, all metabolic parameters were statistically significantly greater for renal metastases compared to RCC and renal lymphoma, and for clear cell RCC compared to papillary RCC. In conclusion, the PET portion of F-18-FDG-PET/CT had a sensitivity of 88% for detection of solid malignant renal lesions in patients with known renal malignancy, and reveals differences in metabolic activity based on histopathological type, which may be useful for purposes of individualized medicine. Further studies are required for more in depth assessment of these preliminary observations. Hell J Nucl Med 2013; 16(1): 19-24 Epub ahead of print: 26-3-2013 Published on line: 10 April 2013