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Diagnosis of Complex Renal Cystic Masses and Solid Renal Lesions Using PET Imaging: Comparison of 11C-Acetate and 18F-FDG PET Imaging

Oyama, Nobuyuki MD*; Ito, Hideaki MD*; Takahara, Noriko MD*; Miwa, Yoshiji MD*; Akino, Hironobu MD*; Kudo, Takashi MD†‡; Okazawa, Hidehiko MD; Fujibayashi, Yasuhisa PhD†§; Komatsu, Kazuto MD; Tsukahara, Kenji MD; Yokoyama, Osamu MD*

doi: 10.1097/RLU.0000000000000287
Original Articles

Purpose The study aims to assess the usefulness of PET with 11C-acetate and 18F-FDG to differentiate renal cell carcinoma (RCC) from complicated renal cysts.

Methods Thirty-one patients were enrolled, 14 patients with complicated renal cysts (12 with Bosniak III and 2 with Bosniak IV) and 17 patients with 19 solid renal tumors. The patients underwent both 11C-acetate PET and FDG PET. Nephrectomy or partial nephrectomy was performed after the PET scans.

Results In 29 patients, 32 renal lesions were diagnosed as RCC. Twenty-three of the 32 RCCs (72%) had positive 11C-acetate PET findings, whereas only 7 FDG PET studies were positive (22%). Considering the relationship between tumor size measured by macroscopic appearance of resected tumors and PET results, 22 of 25 (88%) tumors more than 1.5 cm showed positive 11C-acetate PET findings. In 12 patients with Bosniak III renal cysts, 10 renal lesions were diagnosed as RCC. In this subgroup, 5 of the 10 RCCs (50%) had positive 11C-acetate PET findings, whereas 2 RCCs (20%) had positive FDG PET findings. None of the cases with benign findings had positive 11C-acetate PET or FDG PET scans.

Conclusions 11C-acetate PET demonstrates a pronounced increase in tracer uptake in RCC, especially in renal tumors more than 1.5 cm, and displays a higher sensitivity than FDG PET. These preliminary data show that 11C-acetate may be a useful PET tracer to exclude RCC in complex renal cysts.

From the *Department of Urology, Faculty of Medical Sciences, and †Biomedical Imaging Research Center, University of Fukui, Fukui; ‡Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki; §Molecular Imaging Center, National Institute of Radiological Sciences, Anagawa, Chiba; and ¶Department of Urology, Fukui Red Cross Hospital, Fukui, Japan.

Received for publication April 18, 2013; revision accepted September 19, 2013.

Conflicts of interest and sources of funding: The Grant-in-Aid for Scientific Research (C), 21st Century COE Program (Medical Science), The Japan Society for the Promotion of Science.

Reprints: Nobuyuki Oyama, MD, Department of Urology, University of Fukui, 23-3 Matsuoka-Shimoaizuki. Eiheiji, Fukui 9101193, Japan. E-mail:

© 2014 by Lippincott Williams & Wilkins