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Evaluation of 18F-FDG Excretion Patterns in Malignant Obstructive Uropathy

Cho, Arthur MD*; Chung, Yong Eun MD, PhD; Lee, Jae-hoon MD*; Yun, Mijin MD, PhD*; Lee, Jong Doo MD, PhD*; Kang, Won Jun MD, PhD*

doi: 10.1097/RLU.0b013e31829b2012
Original Articles

Objectives This study aims to evaluate whether 18F-FDG excretion patterns reflect renal function in malignant obstructive uropathy and to evaluate if these patterns predict internal ureteral stent success.

Methods One hundred twelve patients who underwent PET/CT for abdominal tumors and displayed hydronephrosis on CT and 59 patients who underwent PET/CT for cancer screening were included in a retrospective study. Hydronephrosis was graded by initial CT and correlated with visual analysis of 18F-FDG renal parenchymal uptake and excretion patterns. Stent insertion was performed for 84 patients after PET. Follow-up CT was reviewed for hydronephrosis improvement.

Results There were 4 PET patterns in obstructive hydronephrosis which correlated linearly with hydronephrosis severity and serum creatinine levels. Patients with no parenchymal retention and renal excretion (PET pattern 1) showed 97% (28/29) hydronephrosis improvement after stent insertion, and patients with no parenchymal retention and no renal excretion showed 0% (0/9) hydronephrosis improvement after stent insertion. Multivariate analysis showed creatinine levels and PET pattern predicted stent success, but CT hydronephrosis did not.

Conclusions There are 4 PET patterns of obstructive hydronephrosis which correlated with hydronephrosis grade and creatinine levels. Some of these PET patterns can be useful in the prediction of hydronephrosis improvement after stent insertion. Recognition of these patterns in obstructive hydronephrosis may be helpful in improving patient prognosis and quality of life.

From the *Departments of Nuclear Medicine and †Radiology, Yonsei University Health System, Seoul, Korea.

Received for publication January 7, 2013; and revision accepted May 8, 2013.

Conflicts of interest and sources of funding: none declared.

This study was supported by a faculty research grant of Yonsei University College of Medicine for 2010 (6-2010-0026) and by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A101344).

Conflicts of interest and sources of funding: none declared.

Reprints: Won Jun Kang, MD, PhD, Department of Nuclear Medicine, Yonsei University Health System, 134 Shinchon-dong, Seodaemoon-ku, Seoul, Korea, 120-752. E-mail:

© 2013 by Lippincott Williams & Wilkins