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Diuretic 18F-FDG PET/CT imaging for detection and locoregional staging of urinary bladder cancer: prospective evaluation of a novel technique

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Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) has been used with limited success in the past in primary diagnosis and locoregional staging of urinary bladder cancer, mainly because of the pharmacokinetics of renal excretion of 18F-FDG. In the present prospective study, we have evaluated the potential application of diuretic 18F-FDG PET/CT in improving detection and locoregional staging of urinary bladder tumours.


Twenty-five patients suspected of having primary carcinoma of the urinary bladder were evaluated prospectively for diagnosis and staging. All of these 25 patients underwent conventional contrast-enhanced computed tomography (CECT) of the abdomen/pelvis and whole-body diuretic 18F-FDG PET/CT. In addition, pelvic PET/CT images were obtained using the special technique of forced diuresis using intravenous furosemide (20–40 mg). Of the 25 patients, 10 underwent radical cystectomy and 15 underwent transurethral resection of the bladder tumour (TURBT). Results of CECT and diuretic 18F-FDG PET/CT were compared considering histopathology as a reference standard.


Of the 25 patients, CECT detected a primary tumour in 23 (sensitivity 92 %), while 18F-FDG PET/CT was positive in 24 patients (sensitivity 96 %). Mean size and maximum standardized uptake value of the bladder tumours were 3.33 cm (range 1.6–6.2) and 5.3 (range 1.3–11.7), respectively. Of the 25 patients, only 10 patients underwent radical cystectomy based on disease status on TURBT. Among those ten patients, nine had locoregional metastases. Among the nine patients who had positive lymph nodes for metastasis on histopathology, CECT and PET/CT scan had a sensitivity of 44 and 78 %, respectively. 18F-FDG PET/CT was found to be superior to CECT in the detection of the primary tumour and locoregional staging (p < 0.05).


Diuretic 18F-FDG PET/CT is highly sensitive and specific and plays an important role in improving detection of the primary tumour and locoregional staging of urinary bladder tumours. Diuretic 18F-FDG PET/CT demonstrated a higher diagnostic value when compared with CECT in these patients.

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Correspondence to Rakesh Kumar.

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Nayak, B., Dogra, P.N., Naswa, N. et al. Diuretic 18F-FDG PET/CT imaging for detection and locoregional staging of urinary bladder cancer: prospective evaluation of a novel technique. Eur J Nucl Med Mol Imaging 40, 386–393 (2013).

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