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Defining the Added Value of 99mTc-MIBI SPECT/CT to Conventional Cross-Sectional Imaging in the Characterization of Enhancing Solid Renal Masses

Sheikhbahaei, Sara MD, MPH; Jones, Christopher S. MD; Porter, Kristin K. MD; Rowe, Steven P. MD, PhD; Gorin, Michael A. MD; Baras, Alex S. MD; Pierorazio, Phillip M. MD; Ball, Mark W. MD; Higuchi, Takahiro MD, PhD; Johnson, Pamela T. MD; Solnes, Lilja B. MD; Epstein, Jonathan I. MD; Allaf, Mohamad E. MD; Javadi, Mehrbod S. MD

doi: 10.1097/RLU.0000000000001534
Original Articles
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Purpose This study investigates whether the addition of preoperative 99mTc-MIBI SPECT/CT can increase the degree of diagnostic confidence in the differentiation of benign from malignant enhancing renal masses.

Patients and Methods Patients were recruited as part of an institutional review board–approved prospective clinical trial. Forty-eight patients with clinical stage T1 solid renal masses who underwent a 99mTc-MIBI SPECT/CT before partial or radical nephrectomy were evaluated. Conventional CT and MRI, which were approximately performed within 8 weeks before 99mTc-MIBI, were retrospectively retrieved. Based on a 5-point scale (1 = definitely benign, 5 = definitely malignant), 2 blinded readers recorded their degree of confidence for each lesion using conventional imaging before and after reviewing the 99mTc-MIBI uptake ratios. Surgical pathology was considered as the reference standard.

Results Additional review of 99mTc-MIBI SPECT/CT uptake ratios increased diagnostic confidence in the differentiation of solid renal masses in 14/48 lesions (29.2%). In 9 lesions, the addition of 99mTc-MIBI changed the initial confidence levels of malignancy toward benign diagnosis. Postsurgical pathology confirmed the diagnosis of benign histology (oncocytoma/hybrid oncocytic-chromophobe tumors) in 7 and chromophobe renal cell carcinoma (behave as indolent) in 2 of these lesions. 99mTc-MIBI increased the confidence level toward malignancy in 5 cases; all were confirmed as RCC on surgical pathology. The area under the receiver operative characteristic curve was 0.60 for conventional imaging alone and 0.85 after reviewing 99mTc-MIBI (P for difference = 0.03).

Conclusions Preoperative 99mTc-MIBI SPECT/CT enhances the performance of conventional imaging, improving the characterization of benign histologies and lowering the possibility of misclassification.

From the *The Russell H. Morgan Department of Radiology and Radiological Science, †The James Buchanan Brady Urological Institute and Department of Urology, and ‡Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; and §Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.

Received for publication November 9, 2016; revision accepted November 26, 2016.

Conflicts of interest and sources of funding: This study was funded by Buerger Family Scholar Fund and the National Kidney Foundation of Maryland (Philanthropic funds). The authors have no conflicts of interest to disclose.

Correspondence to: Mehrbod S. Javadi, MD, The Russell H. Morgan Department of Radiology and Radiological Science, JHOC 3235, 601 North Caroline St, Baltimore, MD 21287. E-mail: mjavadi@jhmi.edu.

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