呋塞米介入试验在泌尿生殖系统肿瘤^(18)F-FDG PET/CT显像中的应用

The preliminary application of Furosemide intervention on PET/CT imaging for tumor of urogenital system

目的提高18F-脱氧葡萄精(FDG)PET/CT显像对泌尿生殖系统肿瘤的检出方法28例泌尿生殖系统肿瘤患者,行18F-FDGPET/CT显像后30-60min,口服呋塞米(速尿)40mg或静脉注射呋塞米50mg,给药前后多饮水、多排尿,再过30min后憋尿下再次进行局部PET/CT显像。分析比较2次显像结果以利尿18F-FDGPET/CT显像中肝脏和软组织摄取18F-FDG为标准,将正常肾组织和(或)膀胱放射性清除效果分为良好、一般、差结果28例患者肾脏和膀胱促排良好率为85.7%(24/28例)8例初诊原发肿瘤和8例术后肿瘤复发患者,常规PET/CT显像恶性肿瘤病灶难以辨认或显示不清,而利尿PET/CT显像病灶清楚显示;2例初诊肾透明细胞癌和1例错构瘤病灶内无18F-FDG浓聚,呋塞米促排无助于提高病灶的检出9例术后无肿瘤复发者常规和呋塞米介入PET/CT检查均为阴性呋塞米促排后PET对泌尿生殖系统肿瘤的检出灵敏度为88%,与CT(83%)相近(x2=0.232,p>0.05),但38.8%患者因行PET/CT而提高分期。结论呋塞米介入能减少悄液高入射性水平对邻近肿瘤显示的影响。

Objective To investigate the Furosemide intervention to promote the clearance of urinary radioactivity so as to increase the sensitivity of ^18F-fluorodeoxyglucose （FDG） PET/CT imaging for the tumor of the urogenital system. Methods PET/CT imaging was performed in 28 patients with tumor of urogenital system. Furosemide was administrated orally or by intravenous injection 30 - 60 min after initial PET/CT imaging. Then drunk excess water and asked more micturation, and second regional PET/CT imaging was performed after holding urination. Compared consecutive PET/CT images, took the diuretic radioactivity level of liver and soft tissue as standard, the clearance of renal and bladder classified as good, moderate and poor. Results The good clearance was obtained in 85.7% of patients. The tumors, which could not be detected clearly by PET/CT befor the administration of Furosemide, were detected clearly after clearance in 8 cases of primary tumor and 8 cases of relapsed cancer. The use of Furosemide was not useful in 2 cases of renal clear cell carcinoma and 1 case of renal hamartoma due to absence of uptake of ^18F-FDG in the lesions. PET/CT were negative in 9 cases with out relapse before and after clearance. Detection sensitivity of PET/CT was 88 % and was approximate to CT （83 %, x^2 = O. 232, P 〉 0. 05 ）, but 38.8 % patients upstaged by PET/CT. Conclusions The effect of Furosemide to promote the clearance of urinary radioactivity is quite good. It can eliminate the influence of high level of urinary radioactivity and increase the sensitivity of PET/CT imaging for detection tumor of the urogenital system. Also, PET/CT may be more useful for the staging of urogenital system tumor.