Early dynamic PET/CT and 18F-FDG blood flow imaging in bladder cancer detection: A novel approach

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1909 Objectives The present standard protocols for performing hybrid positron emission tomography (PET) and computed tomography (CT) with 18F-fluoro-2-deoxyglucose (18F-FDG) call for data acquisition to start 50-60 min. post-injection (PI) of the radiopharmaceutical. However, this prolonged period of tracer incubation allows its accumulation in the urinary bladder making it difficult, if not impossible, to identify abnormal growths on the surface of this organ. Our objective was to identify bladder wall lesions using a novel PET/CT and 18F-FDG imaging protocol. This novel approach was inspired by the angiogenesis property observed in cancer cells and the delayed excretion of high activity concentration 18F-FDG in urinary bladder by the kidneys. Methods Early (starting at injection time) dynamic PET/CT and 18F-FDG scans were performed on 7 consecutive male patients with pathology confirmed bladder cancer. A series of 5 dynamic scans of 2 min. each, starting at injection time, were obtained on each patient’s bladder using a single bed-position. Areas of increased 18F-FDG blood flow, observed on bladder wall scans, were considered suspicious for cancer and compared to the final pathologic report. Results Five out of 7 patients’ scans displayed increased blood flow activity to bladder wall areas that were pathologically proven to be malignancies. The other 2 patients’ scans that failed to show increased blood flow activity to the bladder walls were classified, based on pathology reports, as true negative and false negative. The average maximum standard uptake values (SUVmax ± SD) observed in bladder wall areas with increased and normal blood flow were 2.7 ± 0.7 and 1.1 ± 1.3 g/mL, respectively. Conclusions Although the sample size of this study was relatively small and a larger population group is needed to confirm these findings, its results strongly suggest that this novel PET/CT and 18F-FDG bladder imaging approach could be the protocol of the future in bladder cancer evaluation

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