Article

IN-VIVO IMAGING OF CELLULAR PROLIFERATION IN RENAL CELL CARCINOMA USING [18]F-FLT PET

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Chapter
The kidneys are located in the retroperitoneal space at the sides of the psoas muscle (D11-L3 tract), about 7 cm in depth from the posterior abdominal wall. The left kidney is typically somewhat more superior in position than the right kidney. The upper poles are normally oriented more medially and posteriorly than the lower poles. The medial margin of each kidney is marked by a deep fissure, known as the renal hilum that acts as a gateway to the kidney.
Article
Cancer staging involves determining the extent cancer has progressed by spreading. Positron emission tomography (PET) and optical imaging techniques are being actively evaluated for staging of renal cell carcinoma (RCC). Many of these techniques remain investigational and validation of early results is necessary, but the potential advantages are clear. PET has the potential to provide noninvasive means of determining histology and malignant potential of a renal mass. Patients with localized disease can be risk-stratified for observation, nephron-sparing surgery, or radical nephrectomy. Patients with metastatic disease may be imaged to determine the best therapy, and treatment response can be monitored with serial imaging. Preliminary studies in optical imaging offer promise in differentiation of normal from malignant renal tissue. Optical imaging techniques have potential to provide histological information without the need to remove the tissue from the patient. This information may be used to diagnose RCC or used intraoperatively to assess surgical margins during partial nephrectomy. Further advances in our understanding of the molecular basis of RCC are expected to produce parallel advances in strategies for molecularly targeted imaging.
Chapter
Urothelial cancer consists of tumors of the bladder, ureters, and renal pelvis. Bladder cancer accounts for ∼ 4% of all cancers in the USA (∼ 70,000 cases), while cancers of the renal pelvis and ureters occur in 5,400 patients. Renal cell carcinoma occurs in about 53,000 adults. The most common histological subtype of bladder cancer is transitional cell while the common cell types for renal cell cancer are clear cell, papillary, and chromophobe. Twenty-five to thirty percent of patients are asymptomatic, and the primary lesion is found on incidental imaging studies. The most common presentations are hematuria, flank pain, and palpable mass in the flank or abdomen. However, symptoms usually appear when the tumor is large and metastatic.
Article
Positron emission tomography (PET) has revolutionized cancer imaging. The current workhorse of molecular imaging, fluorodeoxyglucose (FDG) PET is used in the majority of malignant tumors with a few exceptions. Renal cell carcinoma (RCC) is one of those exceptions because of its variable uptake of FDG, although this variable uptake may actually be an asset in predicting response to some targeted agents, as will be discussed later. Beyond FDG, there is only scattered information in the literature on the use of PET in RCC. The purpose of this review is to summarize the current status of PET usage in RCC and point out its potentials and future directions. We will start with a brief overview of the demographics, molecular pathogenesis, and evolving treatment strategies in RCC because this information is essential for better understanding of uptake of various PET radiotracers in this cancer and their indications. This will be followed by discussing the role of PET in characterization of indeterminate renal masses, in staging and restaging of RCC, and, finally, in predicting and monitoring therapy response. Each of these 3 areas of PET usage will include the relevant radiotracers currently in use or in development.
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