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Initial experience using 99mTc-MIBI SPECT/CT for the differentiation of oncocytoma from renal cell carcinoma.

Rowe SP, Gorin MA, Gordetsky J, Ball MW, Pierorazio PM, Higuchi T, Epstein JI, Allaf ME, Javadi MS - Clin Nucl Med (2015)

Bottom Line: As a result, a large number of patients harboring a benign oncocytoma undergo unnecessary surgical resection.Relative quantification was performed by measuring tumor-to-normal renal parenchyma background ratios.In contrast, the 3 RCCs were profoundly photopenic relative to renal background (range of uptake ratios, 0.21-0.31). 99mTc-MIBI SPECT/CT appears to be of value in scintigraphically distinguishing benign renal oncocytoma from RCC.

View Article: PubMed Central - PubMed

Affiliation: From the *The Russell H. Morgan Department of Radiology and Radiological Science, †The James Buchanan Brady Urological Institute and Department of Urology, and ‡Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; and §Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.

ABSTRACT

Purpose: The differentiation of oncocytoma from renal cell carcinoma (RCC) remains a challenge with currently available cross-sectional imaging techniques. As a result, a large number of patients harboring a benign oncocytoma undergo unnecessary surgical resection. In this study, we explored the utility of 99mTc-MIBI SPECT/CT for the differentiation of these tumors based on the hypothesis that the large number of mitochondria in oncocytomas would lead to increased 99mTc-MIBI uptake.

Patients and methods: In total, 6 patients (3 with oncocytoma and 3 with RCC) were imaged with 99mTc-MIBI SPECT/CT. Relative quantification was performed by measuring tumor-to-normal renal parenchyma background ratios.

Results: All 3 oncocytomas demonstrated radiotracer uptake near or above the normal renal parenchymal uptake (range of uptake ratios, 0.85-1.78). In contrast, the 3 RCCs were profoundly photopenic relative to renal background (range of uptake ratios, 0.21-0.31).

Conclusions: 99mTc-MIBI SPECT/CT appears to be of value in scintigraphically distinguishing benign renal oncocytoma from RCC.

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Related in: MedlinePlus

Representative images of the RCCs included in this study. A, Coronal contrast-enhanced CT, coronal SPECT (B), and coronal SPECT/CT fusion images of a left upper pole Fuhrman grade III clear cell RCC (C) with a representative histologic image (D, HE ×20) (patient 4, white and black arrowheads). E, Axial contrast-enhanced CT, axial SPECT (F), and axial SPECT/CT fusion images of a medial left lower pole unclassified RCC (G) with a corresponding histologic image (H, HE ×20) (patient 5, white and black arrowheads). I, Axial contrast-enhanced CT, axial SPECT (J), and axial SPECT/CT fusion images of an Xp11 translocation RCC (K) with a histologic image (L, HE ×20) (patient 6, white and black arrowheads).
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Figure 4: Representative images of the RCCs included in this study. A, Coronal contrast-enhanced CT, coronal SPECT (B), and coronal SPECT/CT fusion images of a left upper pole Fuhrman grade III clear cell RCC (C) with a representative histologic image (D, HE ×20) (patient 4, white and black arrowheads). E, Axial contrast-enhanced CT, axial SPECT (F), and axial SPECT/CT fusion images of a medial left lower pole unclassified RCC (G) with a corresponding histologic image (H, HE ×20) (patient 5, white and black arrowheads). I, Axial contrast-enhanced CT, axial SPECT (J), and axial SPECT/CT fusion images of an Xp11 translocation RCC (K) with a histologic image (L, HE ×20) (patient 6, white and black arrowheads).

Mentions: The 3 known oncocytomas demonstrated maximum radiotracer uptake similar to or above uptake levels within the adjacent renal parenchyma (average tumor uptake, 1.19; range, 0.85–1.78; Table 1; Fig. 3). In 2 of the patients with oncocytomas, prominent hypoenhancing central scars were observed on separate contrast-enhanced CT scans, and these were also well appreciated as prominent central photopenic defects on 99mTc-MIBI SPECT/CT (patients 1 and 3, Fig. 3). In contrast to the oncocytomas, the 3 RCCs were markedly photopenic relative to the background renal parenchyma, with an average tumor uptake of 0.26 (range, 0.21–0.31; Table 1; Fig. 4). This equates to a greater than 4-fold increase in relative uptake between oncocytoma and RCC, further reinforcing the utility of qualitative assessment of tumor uptake differences.


Initial experience using 99mTc-MIBI SPECT/CT for the differentiation of oncocytoma from renal cell carcinoma.

Rowe SP, Gorin MA, Gordetsky J, Ball MW, Pierorazio PM, Higuchi T, Epstein JI, Allaf ME, Javadi MS - Clin Nucl Med (2015)

Representative images of the RCCs included in this study. A, Coronal contrast-enhanced CT, coronal SPECT (B), and coronal SPECT/CT fusion images of a left upper pole Fuhrman grade III clear cell RCC (C) with a representative histologic image (D, HE ×20) (patient 4, white and black arrowheads). E, Axial contrast-enhanced CT, axial SPECT (F), and axial SPECT/CT fusion images of a medial left lower pole unclassified RCC (G) with a corresponding histologic image (H, HE ×20) (patient 5, white and black arrowheads). I, Axial contrast-enhanced CT, axial SPECT (J), and axial SPECT/CT fusion images of an Xp11 translocation RCC (K) with a histologic image (L, HE ×20) (patient 6, white and black arrowheads).
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Related In: Results  -  Collection

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Figure 4: Representative images of the RCCs included in this study. A, Coronal contrast-enhanced CT, coronal SPECT (B), and coronal SPECT/CT fusion images of a left upper pole Fuhrman grade III clear cell RCC (C) with a representative histologic image (D, HE ×20) (patient 4, white and black arrowheads). E, Axial contrast-enhanced CT, axial SPECT (F), and axial SPECT/CT fusion images of a medial left lower pole unclassified RCC (G) with a corresponding histologic image (H, HE ×20) (patient 5, white and black arrowheads). I, Axial contrast-enhanced CT, axial SPECT (J), and axial SPECT/CT fusion images of an Xp11 translocation RCC (K) with a histologic image (L, HE ×20) (patient 6, white and black arrowheads).
Mentions: The 3 known oncocytomas demonstrated maximum radiotracer uptake similar to or above uptake levels within the adjacent renal parenchyma (average tumor uptake, 1.19; range, 0.85–1.78; Table 1; Fig. 3). In 2 of the patients with oncocytomas, prominent hypoenhancing central scars were observed on separate contrast-enhanced CT scans, and these were also well appreciated as prominent central photopenic defects on 99mTc-MIBI SPECT/CT (patients 1 and 3, Fig. 3). In contrast to the oncocytomas, the 3 RCCs were markedly photopenic relative to the background renal parenchyma, with an average tumor uptake of 0.26 (range, 0.21–0.31; Table 1; Fig. 4). This equates to a greater than 4-fold increase in relative uptake between oncocytoma and RCC, further reinforcing the utility of qualitative assessment of tumor uptake differences.

Bottom Line: As a result, a large number of patients harboring a benign oncocytoma undergo unnecessary surgical resection.Relative quantification was performed by measuring tumor-to-normal renal parenchyma background ratios.In contrast, the 3 RCCs were profoundly photopenic relative to renal background (range of uptake ratios, 0.21-0.31). 99mTc-MIBI SPECT/CT appears to be of value in scintigraphically distinguishing benign renal oncocytoma from RCC.

View Article: PubMed Central - PubMed

Affiliation: From the *The Russell H. Morgan Department of Radiology and Radiological Science, †The James Buchanan Brady Urological Institute and Department of Urology, and ‡Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; and §Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.

ABSTRACT

Purpose: The differentiation of oncocytoma from renal cell carcinoma (RCC) remains a challenge with currently available cross-sectional imaging techniques. As a result, a large number of patients harboring a benign oncocytoma undergo unnecessary surgical resection. In this study, we explored the utility of 99mTc-MIBI SPECT/CT for the differentiation of these tumors based on the hypothesis that the large number of mitochondria in oncocytomas would lead to increased 99mTc-MIBI uptake.

Patients and methods: In total, 6 patients (3 with oncocytoma and 3 with RCC) were imaged with 99mTc-MIBI SPECT/CT. Relative quantification was performed by measuring tumor-to-normal renal parenchyma background ratios.

Results: All 3 oncocytomas demonstrated radiotracer uptake near or above the normal renal parenchymal uptake (range of uptake ratios, 0.85-1.78). In contrast, the 3 RCCs were profoundly photopenic relative to renal background (range of uptake ratios, 0.21-0.31).

Conclusions: 99mTc-MIBI SPECT/CT appears to be of value in scintigraphically distinguishing benign renal oncocytoma from RCC.

Show MeSH
Related in: MedlinePlus