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Impact of forced diuresis with furosemide and hydration on the halo artefact and intensity of tracer accumulation in the urinary bladder and kidneys on [68Ga]Ga-PSMA-11-PET/CT in the evaluation of prostate cancer patients

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Abstract

Purpose

to assess the influence of intravenous hydration and forced diuresis with furosemide in two different dosages (20 vs 40 mg) on the intensity of tracer accumulation in the urinary collection system and on the occurrence of halo artefact surrounding the urinary bladder and kidneys in [68Ga]Ga-PSMA-11-PET/CT scans.

Materials and methods

Comparison of four groups with 50 patients each, receiving different preparation prior to [68Ga]Ga-PSMA-11-PET/CT. Group one, no preparation. Group two, 500 ml sodium chloride administered immediately after tracer injection. Group three, 500 ml sodium chloride and injection of 20 mg furosemide immediately after tracer administration. Group four, 500 ml sodium chloride and injection of 40 mg furosemide immediately after tracer injection. Images were judged visually whether halo artefact was present; semiquantitative measurements were performed with standardised uptake value (SUV).

Results

Halo artefact of the urinary bladder was present in twelve patients without preparation, in eight patients receiving only sodium chloride, in one patient injected with 20 mg furosemide/sodium chloride and in two patients receiving 40 mg furosemide/sodium chloride, showing a median SUVmean in the bladder of 45.8, 14.4, 4.6 and 5.8, respectively. Differences between patient group without preparation and the two groups with furosemide/sodium chloride were statistically significant. Patient groups receiving 20 mg furosemide and 40 mg furosemide did not differ significantly. Renal halo artefacts were observed in 15 patients of group one, in ten patients of group two, in 14 patients of group three and in 14 patients of group four, with corresponding median SUVmean values of 33.9, 32.0, 37.8 and 30.4 (no statistically significant differences).

Conclusion

Performing [68Ga]Ga-PSMA-11-PET/CT, intravenous injection of 20-mg furosemide and 500-ml sodium chloride significantly reduces the number of bladder halo artefacts and intensity of tracer accumulation in the urinary bladder. A total of 40 mg furosemide does not further improve results.

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Acknowledgements

We want to express our gratitude to all the members of our PET staff for their contribution in performing this study.

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Author notes

  1. Christian Uprimny and Steffen Bayerschmidt contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Christian Uprimny, Steffen Bayerschmidt, Alexander Stephan Kroiss, Bernhard Nilica, Anna Svirydenka, Clemens Decristoforo, Gianpaolo di Santo, Elisabeth von Guggenberg & Irene Johanna Virgolini

  2. Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria

    Josef Fritz

  3. Department of Urology, Medical University Innsbruck, Innsbruck, Austria

    Wolfgang Horninger

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  1. Christian Uprimny
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Correspondence to Christian Uprimny.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the principles of the 1964 Declaration of Helsinki and its subsequent amendments [32]. In accordance with our local regulations, ethical approval was waived, as the study was conducted retrospectively from data obtained for clinical purposes. Written informed consent was obtained from all patients prior to the exam, and the retrospective study was conducted according to institutional guidelines and is in compliance with the specific requirements of our country.

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Uprimny, C., Bayerschmidt, S., Kroiss, A.S. et al. Impact of forced diuresis with furosemide and hydration on the halo artefact and intensity of tracer accumulation in the urinary bladder and kidneys on [68Ga]Ga-PSMA-11-PET/CT in the evaluation of prostate cancer patients. Eur J Nucl Med Mol Imaging 48, 123–133 (2021). https://doi.org/10.1007/s00259-020-04846-3

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