Published in:
01-09-2013 | Interesting Image
Pyelo-cystic Reflux in F-18 FDG PET Scan Due to Ureteral Obstruction
Published in: Nuclear Medicine and Molecular Imaging | Issue 3/2013
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A 72-year-old woman with a history of cervical cancer was treated with brachytherapy and chemotherapy. Combined F-18 FDG PET/CT performed for restaging demonstrated increased FDG uptake in a hypodense cystic lesion at the posterior part of the right renal cortex and a hypermetabolic soft tissue mass at the right parailiac region suggestive of a metastatic lymph node causing ureteral obstruction. There had been no FDG uptake in the cystic lesion on the FDG PET/CT study performed 1 year before. These findings suggest that the increased FDG uptake in the cystic lesion was caused by pyelocystic reflux due to ureteral obstruction secondary to parailiac lymph node metastasis (Figs. 1 and 2).
Fig. 1
A 72-year-old woman with a history of cervical cancer was treated with brachytherapy and chemotherapy. The patient was referred to the Nuclear Medicine Department for restaging with F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT). The scan was performed 60 min after intravenous injection of 340 MBq (9.2 mCi) of F-18 FDG. Maximum intensity projection (a), axial fusion (b, d) and CT (c, e) at the level of the upper abdominal and pelvic level images showed increased FDG uptake in a hypodense cystic lesion at the posterior part of the right renal cortex (arrows) and intensely accumulated FDG in the renal pelvis. A hypermetabolic soft tissue mass is also demonstrated at the right parailiac region (bold arrow) on axial slices of the pelvic region, suggestive of a metastatic lymph node causing ureteral obstruction (d, e). The right proximal ureter was dilated. After the initial routine PET/CT images, the patient received an injection of diuretic (40 mg furosemide) intravenously. The patient drank 500 ml of water then and voided. The delayed diuretic PET/CT images (f, g) show persistent increased FDG uptake in the hypodense lesion but partial washout of pelvic activity (arrowhead)
Fig. 2
Axial fusion (a) and CT images (b) from the previous F-18 FDG PET/CT study are shown. There is no FDG uptake in the cystic lesion at the posterior part of the right kidney (arrows).
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