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European Journal of Nuclear Medicine and Molecular Imaging

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01-11-2014 | Original Article

Furosemide diminishes ¹⁸F-fluoroethylcholine uptake in prostate cancer in vivo

Authors: H. Christian Rischke, Teresa Beck, Werner Vach, Gesche Wieser, Anca L. Grosu, Wolfgang Schultze-Seemann, Philipp T. Meyer, Cordula A. Jilg

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2014

Abstract

Purpose

¹⁸F-Fluoroethylcholine (¹⁸F-FECh) is excreted via the urinary system with high activity accumulation in the urinary bladder. Furosemide and oral hydration can be administered concomitantly to reduce urinary activity to provide better detectability of retroperitoneal and pelvic lesions. Currently it is unknown if there is any effect of furosemide on ¹⁸F-FECh uptake in organs, tissues and tumour lesions and the extent to which image quality along the urinary tract may be improved by furosemide.

Methods

We retrospectively analysed 217 ¹⁸F-FECh PET/CT examinations from 213 patients with known prostate cancer (PCa), performed either with oral hydration (109) or furosemide 20 mg together with oral hydration (108). Maximum ¹⁸F-FECh uptake in different organs, tissues, lymph nodes and osseous metastases was quantified in terms of standardized uptake value (SUV) in a volume of interest and compared between the two groups. To characterize the impact of furosemide on lesion detectability a three-point rating scale was used to assess the presence of focal activity spots in the ureters and of perivesicular artefacts.

Results

Patient characteristics and distribution of tumour lesions were well balanced between the two groups. Overall, SUVmax values from normal organs were increased after furosemide compared to the values in patients scanned without furosemide. Significant changes were observed in the salivary glands, liver, spleen, pancreas, kidneys, gluteus muscle and perirenal fat. SUVmax values were significantly decreased after furosemide in lymph node metastases (SUVmax 4.81 ± 2.68 vs. 6.48 ± 4.22, p = 0.0006), but not in osseous metastases. Evaluation of image quality along the urinary tract revealed significantly better depiction of the perivesicular space and significantly less focal tracer accumulation in the ureters in patients receiving furosemide, but the number of detected lymph nodes was not significantly different.

Conclusion

Furosemide administration reduced choline uptake in tumour lesions, especially significant in pelvic lymph node metastases. Although furosemide administration improved image quality, optimal image quality may also be obtained by adequate hydration without the risk of diminishing choline uptake in PCa lesions. Therefore a controlled hydration protocol seems more appropriate than administration of furosemide.

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Title: Furosemide diminishes 18F-fluoroethylcholine uptake in prostate cancer in vivo
Authors: H. Christian Rischke
Teresa Beck
Werner Vach
Gesche Wieser
Anca L. Grosu
Wolfgang Schultze-Seemann
Philipp T. Meyer
Cordula A. Jilg
Publication date: 01-11-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-014-2829-0

At a glance: The STEP trials

Springer Medicine

Furosemide diminishes ¹⁸F-fluoroethylcholine uptake in prostate cancer in vivo

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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