Question:

Which of the following is false regarding the use of FDG PET/CT for evaluation of urothelial tumors:
1. FDG PET/CT is an excellent modality for evaluating primary urothelial tumors.
2. FDG PET/CT is very useful in evaluating for metastases of urothelial tumors.
3. Activity in the ureters segmented by peristalsis can mimic pathologic retroperitoneal nodes or urothelial tumors.
4. Artifacts may occur as a result of bladder filling with radionuclide during the PET scan acquisition.
5. FDG PET/CT interpretation may be complicated by the occasional normal variant of increased FDG in perirenal fat benign renal lesions such as angiomyolipomas.





Answer:

The correct answer for the question "Which of the following is false regarding the use of FDG PET/CT for evaluation of urothelial tumors:" is:

1. FDG PET/CT is an excellent modality for evaluating primary urothelial tumors.



Explanation
A. FDG PET/CT is not an excellent modality for evaluating primary urothelial tumors because these lesions cannot be assessed well on functional images due to the normal excretion of FDG in the renal collecting system. [It is well known that renal cortical and urothelial tumors are extremely difficult to evaluate on FDG PET imaging because 40% of the administered activity is excreted via the kidneys in the first 2 hours[9, 10][9, 10][9, 10][9, 10][9, 10][9, 10][9, 10][9, 10][9, 10][8, 9][8, 9][7, 8][7, 8][7, 8].]

B. FDG PET/CT is very useful in evaluating for metastases of urothelial tumors.  [Although FDG is not a useful tracer for the detection of primary urothelial cancer, it is very useful in evaluating for metastases or recurrent disease.]

C. Activity in the ureters segmented by peristalsis can mimic pathologic retroperitoneal nodes or urothelial tumors.  [Activity in the ureters segmented by peristalsis can also mimic pathologic retroperitoneal nodes or tumors.]

D. Artifacts may occur as a result of bladder filling with radionuclide during the PET scan acquisition.  [In addition, artifacts may occur as a result of bladder filling with radionuclide during the PET scan acquisition.]

E. FDG PET/CT interpretation may be complicated by the occasional normal variant of increased FDG in perirenal fat and benign renal lesions such as angiomyolipomas.  [Interpretation can also be complicated by the occasional normal variant of increased FDG in perirenal brown fat or in benign renal lesions such as angiomyolipomas.]



From the manuscript:
Extraperitoneal Urinary Bladder Perforation Detected by FDG PET/CT
Radiology Case. 2011 Apr; 5(4):32-40


This article belongs to the Nucs section.




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From the manuscript

Extraperitoneal Urinary Bladder Perforation Detected by FDG PET/CT

Free full text article: Extraperitoneal Urinary Bladder Perforation Detected by FDG PET/CT

Abstract
Accurate localization of areas of increased metabolic activity on PET only imaging can be challenging. Fusion of PET with CT imaging provides anatomic detail which aids in localization of functional information. As a result, the overall sensitivity and specificity of information provided by PET or CT alone is improved with combined PET/CT resulting in improved diagnosis and patient management. We report a case of an unexpected emergent finding of urinary bladder perforation on PET/CT to stress the importance of accurately interpreting the anatomic and functional data. To our knowledge, diagnosis of bladder perforation on PET/CT has not been previously reported in the literature. Failure to recognize such complications may lead to adverse outcomes.






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