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Original research article


Contrast enhanced computed tomography characterization of fluorodeoxygluocose-avid regional and non-regional lymph nodes in patients with suspicion of metastatic bladder cancer.

Muhammad A ChaudhryRichard WahlLujaien Al-Rubaiey KadhimAtif Zaheer
1Russell H. Morgan Department of Radiology and Radiological Health Sciences, Division of Diagnostic Imaging, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA, Division of Nuclear Medicine, Tawam Molecular Imaging Centre, Al Ain, United Arab Emirates
Date of Submission: 11-Sep-2013, Date of Acceptance: 08-Oct-2013, Date of Web Publication: 31-Dec-2013.
Corresponding Author:
Corresponding Author

Atif Zaheer

Johns Hopkins University School of Medicine, JHOC 3235A Radiology, 601 North Caroline Street, Baltimore, MD 21287, USA.
E-mail: azaheer1@jhmi.edu

Corresponding Author:
Corresponding Author

Atif Zaheer

Johns Hopkins University School of Medicine, JHOC 3235A Radiology, 601 North Caroline Street, Baltimore, MD 21287, USA.
E-mail: azaheer1@jhmi.edu

DOI: 10.4103/2156-7514.124104 Facebook Twitter Google Linkedin

ABSTRACT



Objective: The objective of this study is to assess if size alone can predict the presence of metastatic disease within lymph nodes seen on contrast enhanced-computed tomography (CE-CT) in patients with suspicion of metastatic bladder cancer and also to evaluate the nodal distribution and morphological characteristics of fluorodeoxygluocose (FDG) avid lymph nodes on CE-CT.
Materials and Methods: A retrospective analysis from 2002 to 2009 was performed on patients with suspicion of recurrent disease undergoing restaging FDG-positron emission tomography (PET)/CT. Standardized uptake value (SUVmax) adjusted for lean body mass was recorded in abnormal lymph nodes in the abdominopelvic region. Distribution, size, shape, presence of necrosis and clustering of the FDG-avid lymph nodes was assessed on CE-CT obtained within 4 weeks of the PET/CT. The abnormal nodes were then compared with non-FDG avid lymph nodes on the contralateral side serving as control.
Results: A total of 103 lymph nodes were found to be FDG-avid in 14 patients on 17 PET/CT examinations. Overall, mean SULmax was 4.7 (range: 1.6-10.7), which is significantly higher than background of 1.5 (P < 0.05). Regional pelvic lymph nodes were FDG-avid in 93% of patients and metastatic extra-pelvic in 100% of patients. The overall average size of the FDG avid lymph nodes on CE-CT was 11 mm with a third of these measuring 3-8 mm. The average size of FDG-avid lymph nodes was 11 mm in the paraaortic region 13 mm in the common iliac 9 mm in the internal iliac and 13 mm in the external iliac regions. Nearly 88.4% of lymph nodes were round in shape, clustering was present in 68% and necrosis in 7% and average size of lymph nodes that served as controls was 6 mm with reniform morphology in 92% and absence of clustering and necrosis.
Conclusion: Overlap in size exists between FDG-avid pathological and non-pathological lymph nodes seen on CE-CT in patients with metastatic bladder cancer. Other characteristic such as abnormal morphology and clustering are useful adjuncts in the evaluation of nodal metastatic disease.
Keywords: Bladder Cancer, Contrast-enhanced Imaging, Fluorodeoxygluocose Positron Emission Tomography/computed Tomography

Cited in 3 Documents

  1. Anna Rita Cervino, Lea Cuppari, Pasquale Reccia, Marta Burei, Giorgio Saladini and Laura Evangelista (2018) The role of PET/CT in the evaluation of patients with urothelial cancer: a systematic review and meta-analysis. Clin Transl Imaging 6(2):77. doi: 10.1007/s40336-018-0269-8
  2. Atif Zaheer, Vibhor Wadhwa, Joseph Oh and Elliot K. Fishman (2015) Pearls and pitfalls of imaging metastatic disease from pancreatic adenocarcinoma: a systematic review. Clinical Imaging 39(5):750. doi: 10.1016/j.clinimag.2015.04.017
  3. Fabio Zattoni, Elena Incerti, Michele Colicchia, Paolo Castellucci, Stefano Panareo, Maria Picchio, Federico Fallanca, Alberto Briganti, Marco Moschini, Andrea Gallina, Jeffrey R. Karnes, Val Lowe, Stefano Fanti, Riccardo Schiavina, Ilaria Rambaldi, Vincenzo Ficarra and Laura Evangelista (2018) Comparison between the diagnostic accuracies of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging in recurrent urothelial carcinomas: a retrospective, multicenter study. Abdom Radiol 43(9):2391. doi: 10.1007/s00261-017-1443-6

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