| BackgroundBladder cancer is a common tumor of urinary system,which is more common in men than in women.Most of the early clinical symptoms are painless intermittent hematuria,70% of the patients are superficial tumors,and about 30% of the bladder cancer infiltrates the muscular layer.Therefore,early diagnosis of bladder cancer can significantly improve the clinical treatment effect of patients,reduce the recurrence rate of lesions,and prolong the survival time and quality of life of patients.At present,cystoscopy and histopathology are the gold standard for the diagnosis of bladder cancer,but cystoscopy will cause certain trauma to patients,and may lead to iatrogenic injury and infection.Ultrasound,CT and MRI are the common imaging methods for bladder cancer,but the information provided by conventional imaging is limited.18F-FDG PET/CT is currently a high-end imaging device along the discipline before molecular imaging.In the early stage of the disease,the focus can be found in time,the anatomical tissue location of the focus can be fused with the qualitative image of functional metabolism,and the whole body imaging can be realized in a single examination.Therefore,it has a significant advantage in the clinical staging of bladder cancer.However,18F-FDG is mainly metabolized by urinary system,most of which is concentrated in bladder urine.A large amount of radioactive urine in bladder seriously interferes with the detection of primary focus of bladder by PET/CT,which limits the application of 18F-FDG PET/CT in the diagnosis of primary focus of bladder.In this study,the influence of radioactive urine on the detection rate of bladder tumor was eliminated by oral furosemide and the time of intervention.ObjectiveTo explore the effect of 18F-FDG PET/CT on bladder tumor imaging with simultaneous method(patients taken 40 mg furosemide orally,and then inject 18F-FDG intravenously)and the conventional fractional method(40 mg furosemide was taken orally after 80 minutes of intravenous injection of 18F-FDG)respectively,and then obtain the best intervention time of oral furiamide and improve the detection rate of bladder tumor lesions.MethodsProspective collection and analysis of a total of 60 patients with suspected bladder tumors undergoing other imaging examinations(ultrasound,CT,or MRI,etc.)in Henan Province People’s Hospital from October 2018 to December 2019.There were 39 males and 21 females.The age range was 39-82 years,and the average age was 51 years.Exclusion criteria:(1)patients who have undergone surgical resection of the lesions;(2)contraindications for diuretics for patients with renal insufficiency;(3)failure to complete the whole process of 18 F-FDG PET/CT imaging with oral furosemide;(4)long-term diabetes patient.Collect all clinical data and medical history of patients,including laboratory examination results,various medical images,gender,age,history of diabetes,whether to perform puncture examination,whether to perform barium meal digestive tract examination.All patients underwent 18F-FDG PET/CT scans,of which 30 cases were performed the simultaneous method(patients taken 40 mg furosemide orally,and then inject 18F-FDG intravenously)and 30 cases were performed the conventional fractional method(40 mg furosemide was taken orally after 80 minutes of intravenous injection of 18F-FDG).All patients were hospitalized for enquiry or telephone follow-up within 3 months to obtain the pathological results and clinical prognosis.Review PET/CT fusion images,CT scan images,and PET images of all patients.The images were compared and analyzed frame by frame to determine the metabolic degree,morphology,location of the lesions in the bladder,and the urine metabolism in the bladder.Compare the effective clearance rate of bladder urine,the overall average of bladder tumor SUVmax/bladder urine SUVmax,the length of examination time,and the dose of CT radiation received by patients in different control groups.The area of interest(ROI)of the lesion was manually drawn from the PET/CT fusion image,and the maximum value of the standard uptake value(SUVmax)was calculated using the Medex workstation.For the measurement of SUV value,the maximum SUV of bladder lesion and the maximum of SUV of bladder urine were selected,and the ratio of lesion SUVmax and bladder urine SUVmax obtained by the two methods was calculated,and SPSS 22.0 software was used to perform an independent sample t test.Results1.The sensitivity of 18F-FDG PET/CT imaging to bladder tumor was 100% in both simultaneous and fractional methods.It can be seen that these two 18F-FDG PET/CT imaging methods have high sensitivity and specificity to bladder tumors.2.The mean number of bladder tumor SUVmax / bladder urine SUVmax in the simultaneous group was 3.89,and the fractional group was 5.13.The difference was statistically significant(P <0.05).3.The total length of examination in the simultaneous patient group is the time from the injection of the radiopharmaceutical 18F-FDG to the end of the PET/CT scan.The 30 patients who received the fractionation method took oral furazide 80 minutes after injection,so the fractionation method took longer than the simultaneous method.The difference was statistically significant(P <0.05).4.Patients with bladder tumor lesions in the two groups underwent routine,dual-time and three-time imaging scans.The fractional group accounted for a higher proportion of the two-time and three-time imaging cases than the simultaneous method.The difference was statistically significant(P <0.05).Conclusionsthe simultaneous method and fractional methods can effectively clear the interference of radioactive urine in the bladder to the lesion,but the simultaneous 18F-FDG PET/CT imaging has the following advantages: shorten examination time,reduce CT radiation dose to patients,improve the use efficiency of PET/CT equipment,and reduce staff exposure time.Therefore,the method of intravenous injection of 18F-FDG after oral administration of furosemide has certain advantages over the conventional fractionation method,and it is worth promoting in clinical work. |
PDF Full Text Request