Abstract
The aim of this retrospective study was to evaluate the role of delayed images after forced diuresis coupled with oral hydration in abdominopelvic 18F-FDG PET/CT. Forty-six patients consisting of 17 urological diseases, 9 gynecological tumors, 18 colorectal malignancies, and 2 cancers of unknown primary site were retrospectively analyzed. All patients who presented with indeterminate or equivocal abdominopelvic foci on standard 18F-FDG PET/CT underwent a delayed abdominopelvic imaging after administration of 20mg furosemide intravenously and extra water intake of 500mL. PET/CT images before and after furosemide were compared with each other and their findings correlated with pathology or clinical follow-up (>6months). On initial PET/CT, the glucose metabolism characters of lesions were disguised by radioactive urine, or some undetermined 18F-FDG accumulating foci near the urinary tract appeared. While postdiuretic PET/CT demonstrated an excellent urinary tracer washout, and hypermetabolic lesions could be clearly detected and precisely localized in all cases. On the other hand, the suspected active foci caused by potential stagnation of excreted 18F-FDG in urinary tract were eliminated. The sensitivity, specificity, and accuracy were 94.4% (34/36), 8/10, 91.3% (42/46), respectively. Furthermore, the additional lesions with surrounding invasion or locoregional metastasis were discovered in 8 of 46 (17.4%) patients only by the delayed images, including 2 gynecological and 6 rectal malignancies. Detection of abdominopelvic malignancies can be improved using delayed 18F-FDG PET/CT images after a diuretic and oral hydration.
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