Use of <scp><sup>99m</sup>Tc‐sestamibi SPECT/CT</scp> for indeterminate renal tumours: a pilot diagnostic accuracy study

Warren, Hannah; Boydell, Anna‐Rita; Reza, Abbas; Pencharz, Deborah; Holman, Beverley F; Elsheikh, Somaia; Wildgoose, William H.; Barod, Ravi; Patki, Prasad; Mumtaz, Faiz; Bex, Axel; Wagner, Thomas; Tran, Maxine

doi:10.1111/bju.15879

Cited by 5 publications

(2 citation statements)

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“…The important role of pH in renal tumours is exemplified by the extracellular expression of carbonic anhydrase IX (CAIX) as a pH regulator 35 , and can be demonstrated using PET as well as on immunohistochemistry in the context of ccRCC 36 . Metabolic rewiring of renal cancer can be indirectly imaged using 99 Tc-sestamibi with single-photon emission computed tomography (SPECT) which detects high mitochondrial density 37 . This is a characteristic of oncocytic neoplasms where defective mitochondria accumulate due to an impaired respiratory complex I, resulting in hypoxia 38 .…”

Section: Discussionmentioning

confidence: 99%

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

Horvat-Menih,

Birchall,

Zamora-Morales

et al. 2024

Preprint

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BackgroundAccurate non-invasive subtyping of localised kidney tumours is an unmet clinical question in uro-oncology. Differentiation of benign renal oncocytomas (RO) from malignant chromophobe renal cell carcinomas (chRCC) is not possible using conventional imaging. Despite the importance of renal function for sodium regulation, little is known about sodium handling in kidney tumours.PurposeHere we used non-invasive sodium MRI (23Na-MRI) to quantify sodium concentration and relaxation dynamics across a range of different kidney tumour subtypes and have correlated these findings with imaging surrogates for perfusion, hypoxia, and cellularity.Materials and MethodsBetween January and April 2023, patients with localised renal masses were prospectively recruited and underwent23Na and proton (1H) MRI at 3T to acquire 3D maps of B1, total sodium concentration (TSC), proton and sodium relaxation rates (R2*), and diffusion weighted imaging (DWI). Statistical analysis included comparison and correlation of quantified imaging parameters across kidney tumour subtypes.ResultsTen patients were included in the final analysis (mean age±S.D. = 64±8 years; 7:3 male:female ratio) encompassing seven ROs, two chRCCs, two clear cell RCCs (ccRCC), and one papillary RCC (pRCC). The TSC was significantly higher in the ROs compared to the chRCCs: 162±58 mM vs. 71±2 mM (P< 0.05). The mean TSC in ccRCC was 135±59 mM, and 81 mM in pRCC. The23Na-derived and1H-derivedR2* values showed a weak correlation (Spearman r = 0.17;P= 0.50). There was a significant inverse correlation between TSC and1H-R2* (Spearman r = -0.39,P< 0.05), but TSC was independent of the DWI-derived imaging parameters.Conclusion23Na-MRI detected markedly different sodium concentrations within benign ROs and malignant chRCCs. In addition, the sodium signal inversely correlated with1H-R2* as a surrogate for hypoxia. Therefore we have shown the feasibility and potential of23Na-MRI for future research in renal tumours.Key results23Na-MRI was used to non-invasively assess kidney tumour subtypes for the first time.A significantly higher total sodium concentration was detected in benign renal oncocytoma (162±58 mM), compared to chromophobe renal cell carcinoma (71±2 mM), as the malignant counterpart:P< 0.05.Total sodium concentration showed a significant inverse correlation with1H-R2* (Spearman r = -0.39,P< 0.05), but it was independent of the diffusion-weighted imaging-derived parameters.Summary statement23Na-MRI showed potential for differentiating benign and malignant masses, to characterise kidney tumours, which may be linked to the underlying differences in deoxygenation as measured with1H-MRI.

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Section: Discussionmentioning

confidence: 99%

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

Horvat-Menih,

Birchall,

Zamora-Morales

et al. 2024

Preprint

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“…Schober et al are early adopters of 99m Tc-sestamibi SPECT/CT, and we commend them for publishing their real-world experience of using 99m Tc-sestamibi SPECT/CT to inform decision making in select cases ( 4 ). 99m Tc-sestamibi SPECT/CT has shown high diagnostic accuracy in several single-centre series for the detection of renal oncocytomas and low grade oncocytic tumours (LOT) ( 5 - 10 ). A recent systematic review and meta-analysis showed 89% sensitivity and specificity for the detection of oncocytomas and LOTs versus other tumour types against a reference standard of histopathology ( 11 ).…”

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confidence: 99%

99mTc-sestamibi SPECT/CT—the jury is still out!

Warren,

Tran

2024

Transl Androl Urol

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The Role of 99mTc‐Sestamibi Single-photon Emission Computed Tomography/Computed Tomography in the Diagnostic Pathway for Renal Masses: A Systematic Review and Meta‐analysis

Basile,

Fallara,

Verri

et al. 2024

European Urology

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Use of ^99mTc‐sestamibi SPECT/CT for indeterminate renal tumours: a pilot diagnostic accuracy study

Cited by 5 publications

References 7 publications

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

99mTc-sestamibi SPECT/CT—the jury is still out!

The Role of 99mTc‐Sestamibi Single-photon Emission Computed Tomography/Computed Tomography in the Diagnostic Pathway for Renal Masses: A Systematic Review and Meta‐analysis

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Use of 99mTc‐sestamibi SPECT/CT for indeterminate renal tumours: a pilot diagnostic accuracy study

Cited by 5 publications

References 7 publications

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

99mTc-sestamibi SPECT/CT—the jury is still out!

The Role of 99mTc‐Sestamibi Single-photon Emission Computed Tomography/Computed Tomography in the Diagnostic Pathway for Renal Masses: A Systematic Review and Meta‐analysis

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Use of ^99mTc‐sestamibi SPECT/CT for indeterminate renal tumours: a pilot diagnostic accuracy study