PET/CT and Renal Pathology: A Blind Spot for Radiologists? Part 1, Primary Pathology

Zukotynski, Katherine; Lewis, Aaron; O’Regan, Kevin; Jacene, Heather A.; Sakellis, Christopher G.; Krajewski, Katherine M.; Israel, David

doi:10.2214/ajr.11.7790

Cited by 33 publications

(12 citation statements)

References 12 publications

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“…Ye et al recently reported that the FDG uptake by lymphoma lesions was much higher than that by renal carcinomas, suggesting that PET/ CT could be useful for the diagnosis of renal lymphoma (35). A similar pattern for PET/CT imaging has also been reported for the papillary and chromophobe subtypes of RCC (36). Therefore, in addition to the traditional ultrasound, CT or magnetic resonance imaging (37), the use of PET/CT could help radiologists to suggest or raise the possibility of lymphoma as a possible diagnosis.…”

Section: Discussionsupporting

confidence: 55%

Primary Renal Lymphoma: A Case Report and Literature Review

et al. 2015

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Primary renal lymphoma (PRL) is a rare disease which is often mistaken for renal cell carcinoma. In the present study, a 56-year-old man visited a clinic complaining of an intermittent fever and right flank pain. A computerized tomography examination revealed a hypoenhancing mass in his right kidney. Radical nephrectomy was conducted, and a diagnosis of diffuse large B-cell lymphoma was confirmed. The present case was determined to be a true PRL according to the results of a positron emission tomography examination and a bone marrow biopsy to rule out any lymphoma invasions apart from the right kidney.

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Section: Discussionsupporting

confidence: 55%

Primary Renal Lymphoma: A Case Report and Literature Review

et al. 2015

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“…FDG-PET/CT has the advantage that the risk of falsenegative results (namely missing a malignant adrenal tumor) is quite low, and this refers mainly to a few subtypes of extra-adrenal malignancies with low uptake (174,175,176,177). This procedure is, however, more expensive, not always easily available, and has the disadvantage that several benign adrenal tumors (e.g.…”

Section: Reasoningmentioning

confidence: 99%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,254

1,571

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By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected recommendations: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1 mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50 nmol/L (1.8 µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1 mg dexamethasone >138 nmol/L (>5 µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients www.eje-online.org European Journal of Endocrinology175:2 G2 Clinical Practice Guideline M Fassnacht and others ESE and ENSAT guideline on adrenal incidentalomawith an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal inciden...

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“…Most of the RCCs in the present study (15/22 [68.2%]) showed histologic findings of clear cell RCCs, with an SUV max lower than 5.26 g/mL noted in all cases. The reported FDG avidity of RCCs is variable and depends not only on the subtype but also on the cell degree of differentiation, because high-grade RCC often shows increased FDG up- take [14, 15]; thus, an overlap between high-grade RCCs and lymphomas is conceivable. In the present study, all renal lymphomas were FDG avid, which is in line with previous observations [13, 16]; all renal lymphomas had an SUV max higher than 5.98 g/mL.…”

Section: Discussionmentioning

confidence: 99%

Renal Masses Detected on FDG PET/CT in Patients With Lymphoma: Imaging Features Differentiating Primary Renal Cell Carcinomas From Renal Lymphomatous Involvement

Nicolau

Sala

Kumar

et al. 2017

American Journal of Roentgenology

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OBJECTIVE The purpose of this study is to analyze the 18F-FDG PET/CT features of solid renal masses detected in patients with lymphoma and to evaluate the ability of PET/CT to differentiate renal cell carcinoma (RCC) from renal lymphomatous involvement. MATERIALS AND METHODS Thirty-six patients with solid renal masses on PET/CT performed for staging or follow-up of lymphoma were evaluated retrospectively. The features recorded for each renal mass included the following standardized uptake values (SUVs) on PET/CT: the maximum SUV (SUVmax), the mean SUV (SUVmean), the ratio of the SUVmax of the tumor to that of the normal kidney cortex, the ratio of the SUVmean of the tumor to that of the normal kidney cortex, the ratio of the SUVmax of the tumor to that of the normal liver, and the ratio of the SUVmean of the tumor to that of the normal liver. Renal mass size and margins (well defined vs infiltrative) and the presence of calcifications were evaluated on CT. Renal biopsy results were used as the reference standard. Relationships between imaging parameters and histopathologic findings were assessed. RESULTS Of the 36 renal masses evaluated, 22 (61.1%) were RCCs and 14 (38.9%) were renal lymphomas. All SUV metrics were higher for renal lymphomas than for RCCs (p< 0.0001, for all). All renal lymphomas had an SUVmax higher than 5.98 g/mL (median, 10.99 g/mL), whereas all RCCs had an SUVmax lower than 5.26 g/mL (median, 2.91 g/mL). No statistically significant differences in mass size or margins were found between RCCs and renal lymphoma. CONCLUSION PET/CT features may be useful for differentiating RCCs from renal involvement in patients with lymphoma with solid renal masses.

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PET/CT and Renal Pathology: A Blind Spot for Radiologists? Part 1, Primary Pathology

Abstract: Close attention to both the FDG PET and CT portions of the study is essential to interpret renal pathology correctly on FDG PET/CT examinations.

Cited by 33 publications

References 12 publications

Primary Renal Lymphoma: A Case Report and Literature Review

Primary Renal Lymphoma: A Case Report and Literature Review

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Renal Masses Detected on FDG PET/CT in Patients With Lymphoma: Imaging Features Differentiating Primary Renal Cell Carcinomas From Renal Lymphomatous Involvement

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