Clinical Application Of¹¹C-Acetate And¹⁸F-FDG PET/CT In Diagnosis Of Urinary System Tumour

Object iveThe purpose is to study the feasibility of using11C-Acetate(11C-ACE)PET/CT for detecting urinary system tumour and evaluate the clinical diagnosis effect of11C-Acetate used as a complement of18F-FDG.Materials and Methods26patients suspicious of urinary system malignancy tumor and without any systematic therapy were collected between11/2010-03/2012, which include15cases of kindey occupying lesions and11of suspicious prostate diease.20male and6female with age between33and80underwent whole body18F-FDG PET/CT scan and abdominal or peivic cavity11C-Acetate PET/CT scan in one week. Partial patients underwent pelvic cavity delay scan when necessary. And partial patients underwent abdominal CT enhancement scanning.11case of the15kindey tumor were confirmed as malignant renal cell cancer by histopathologically(by operation or puncture), including6cases of clear cell carcinoma of kindey,3cases of papilla cell carcinoma, renal pelvic carcinoma and1case of urothelium carcinoma. For the other4cases were confirmed as benign lesion, including1case of angioleiomyolipoma (by operation),1case of cyst of kindey and2cases of other benign disease (by the follow up CT scan and clinical follow up).7case of11suspicious prostate disease were confirmed as prostate cancer(by operation or puncture).2cases were confirmed as benign prostate hyperplasy (by operation or clinical follow up).1case was confirmed as normal prostate and the last lease was confirmed as prostatitis(clinical follow up).7cases of the9patients accompying with increaseing blood serum of PSA were finally confermed as prostate cancer.The other2cases were confirmed as benign prostate hyperplasy.3cases of prostate cancer were accompanying with lymph nodes and osseous metatasis.For semiquantitative analysis, SUVmax were calculaed by ROI mothed, the diagnoses of malignant urinary system tumor and in PET images were made by two nuclear medicine doctors with a criterion of standardized uptake value(SUVmax≥2.5), a lesion is calssified "+" by both visual assessment and a semi-quantitative SUVmax≥2.5,"-" when its activity is same as that in nontumor tissue and SUVmax<2.5. Imaging information were interpreted and compared with the histopathology findings or with clinical follow-up results. The sensitivity, specificity and accuracy of11C-acetate and18F-FDG PET/CT scan were calculated. The matching chi-square test was used to analyze the date. And the correlation analysis of prostate cancer with "C-acetate and18F-FDG PET/CT were carrier out.Results1. The sensitivity of11C-acetate PET/CT scan in diagnosis of kindey clear cell carcinoma up to80percent of renal cell carcinorma is100%, which greatly make up the deficient of18F-FDG in the diagnosis of kindey tumor. And the relationship between11C-acetate and18F-FDG is complementation, for the other type of renal cell carcinoma11C-acetate displayed "-" results.When combined two radiotracers scan, the sensitivity can be greatly raised. For the metastatic lymph nodes of3renal cases, the uptake of the radioactice tracer is consistent with the primary tumor. But because of the samll number, the futher more study is needed.2. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of11C-acetate is respectively45.5%,75%,53.3%,83.3%and30%. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of18F-FDG is respectively45.5%,100%,60%,100%and40%.The sensitivity,specificity, accuracy, masculine predictive value and negative predictive value of combined two radioactice tracer scan is respectively100%,50%,86.7%,84.6%and100%. By statistics analysis, only sensitivity has statistical significance of "C-acetate PET/CT scan,18F-FDG PET/CT scan and combined11C-acetate and18F-FDG PET/CT scan (P=0.0090).3.4renal benign cases of18F-FDG were displayed as negative results, while3cases of11C-acetate with negative results and1case wth false positive result(SUVmax of11.5) which was confirmed as angioleiomyolipoma.4. For11cases of suspicious prostate diease, the diagonisis value of11C-acetate has no obviously variance compared with18F-FDG PET/CT scan(P=0.2801). The diagnosis value of the two radioactive traces for prostate cancer has no statistically significant compared with sigle tracer agnent(P=0.2231).5.4cases of prostate carcinoma accopanying with bone metastasis and2cases with matastatic lymph nodes are noted in this study. Besides, there is1case which was confined as non-prostate cancer combined with mutiple osseous metastasis. The SUVmax of partial bone metatasis of11C-acetate are obviously higher than18F-FDG. But partial are lower than18F-FDG. Maybe this has the correlation with the pathological grades. But because of the samll number, further more study is needed.6. The Pearson correlation coefficient of PSA and18F-FDG is0.325, which mean low grade correlation of the two variances. The Pearson correlation coefficient of FPSA and18F-FDG is0.644, which mean medial grade correlation of the two variances. The Pearson correlation coefficient of F/T and18F-FDG. is0.484, which mean low grade correlation of the two variances. The Pearson correlation coefficient of PSA and11C-acetate. is-0.014, which mean no correlation of the two variances. The Pearson correlation coefficient of FPSA and111C-acetate. is-0.614, which mean no correlation of the two variances. The Pearson correlation coefficient of F/T and11C-acetate is0.748, which mean medial grade correlation.But all the aboved mentioned correlation has no statistically significant.Conelus ion1. Combination of11C-acetate and18F-FDG PET/CT scan can be useful in increasing sensitivity of renal cancer diagnosis.2.11C-acetate PET/CT scan shows better detection rate than18F-FDG PET/CT scan in diagnosis of renal clear cell carcinoma, which can complement the insufficient of18F-FDG PET/CT scan in diagnosis of clear cell carcinoma. But18F-FDG can not be replaced by11C-acetate, the relationship between11C-acetate and18F-FDG is complementary to each other.3.11C-acetate PET/CT scan or combination of11C-acetate and18F-FDG PET/CT scan has no better diagnostic value in distinguishing benign lesion with malignant occupying lesion in the prostate than18F-FDG PET/CT scan. 4. No correlation relationship is confirmed between SUVmax of11C-acetate or18F-FDG and PSA, FPSA or F/T.