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Abstract
We evaluated the value of F-18 fluorodeoxyglucose (FDG) and C-11 methionine positron emission tomography/computed tomography (PET/CT) to predict high-Fuhrman grade and advanced-stage tumours in patients with renal cell carcinoma (RCC). Forty patients with RCC underwent F-18 FDG and C-11 methionine PET/CT between September 2016 and September 2018. They were classified into limited (stages I and II, n = 15) or advanced stages (stages III and IV, n = 25) according to pathological staging. Logistic regressions were used to predict the advanced stage using various parameters, including maximum standardised uptake value (SUVmax) and metabolic tumour volume (MTV). Receiver operating characteristic analyses were performed to predict high-grade tumours (Fuhrman 3 and 4). On univariate analysis, tumour size, SUVmax and MTV of F-18 FDG and C-11 methionine, and Fuhrman grades were significant predictors for the advanced stage. On multivariate analysis, F-18 FDG MTV > 21.3 cm3 was the most significant predictor (p < 0.001). The area under the curve for predicting high-grade tumours was 0.830 for F-18 FDG (p < 0.001) and 0.726 for C-11 methionine PET/CT (p = 0.014). In conclusion, glycolysis on F-18 FDG PET/CT and amino acid metabolism on C-11 methionine PET/CT were variable but increased in high-grade RCCs. Increased MTV on F-18 FDG PET/CT is a powerful predictor of advanced-stage tumours.

Affiliations

Suk-Hyun Lee  1   2 , Jee-Soo Park  3 , Hyunjeong Kim  4 , Dongwoo Kim  1 , Seung-Hwan Lee  3 , Won-Sik Ham  3 , Woong-Kyu Han  3 , Young-Deuk Choi  3 , Mijin Yun  1
1 Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea.
2 Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Korea.
3 Department of Urology, Urologic Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03772, Korea.
4 Department of Nuclear Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 17046, Gyeonggi-do, Korea.