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INTERESTING IMAGE
Year : 2018  |  Volume : 33  |  Issue : 2  |  Page : 165-166  

Posterior Layering of Fluorine-18 Fluorodeoxyglucose in the Urinary Bladder


Department of Nuclear Medicine, Hospital Pulau Pinang, Penang, Malaysia

Date of Web Publication15-Mar-2018

Correspondence Address:
Dr. Alex Cheen Hoe Khoo
Department of Nuclear Medicine, Hospital Pulau Pinang, Jalan Residensi George Town 10990, Penang
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_148_17

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   Abstract 


An 89-year-old man undergoing fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) study posttherapy for hepatocellular carcinoma was noted to have 18F-FDG posterior layering of the urinary bladder. This phenomenon of posterior layering of 18F-FDG in the urinary bladder during PET/CT studies is physiological, and it is important to recognize to avoid misinterpretation and unnecessary investigations. The hypotheses for the cause of this phenomenon are highlighted in these interesting images including the reversed phenomenon where there is anterior layering of 18F-FDG.

Keywords: Fluorine-18 fluorodeoxyglucose, positron emission tomography/computed tomography, layered urine, urinary bladder, delayed urine excretion, urine sedimentation


How to cite this article:
Hoe Khoo AC. Posterior Layering of Fluorine-18 Fluorodeoxyglucose in the Urinary Bladder. Indian J Nucl Med 2018;33:165-6

How to cite this URL:
Hoe Khoo AC. Posterior Layering of Fluorine-18 Fluorodeoxyglucose in the Urinary Bladder. Indian J Nucl Med [serial online] 2018 [cited 2019 Dec 8];33:165-6. Available from: http://www.ijnm.in/text.asp?2018/33/2/165/227501



An 89-year-old man with coronary artery disease, hypertension, and gout was diagnosed with hepatocellular carcinoma in February 2017. In fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) study in September 2017, he was noted to have posterior layering of 18 F-FDG in the urinary bladder [Refer to [Figure 1] and [Figure 2] in addition to the multiple metabolically active lesions in the liver and lungs.
Figure 1: The urine with 18F-FDG is seen layered to the urine without 18F-FDG in the urinary bladder (a:axial CT view; b: axial pet view; fused PET/CT view)

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Figure 2: Other fused PET/CT images demonstrating 18F-FDG layering in the urinary bladder (a: sagittal view; b: coronal view)

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The incidence of this physiological phenomenon is reported to be 4%. There are few hypotheses for this phenomenon. One hypothesis suggests the delayed urinary excretion of 18 F-FDG and the delayed mixing of urine-containing 18 F-FDG with nonradioactive urine. This layering is more likely to occur in patients with the distended bladder.[1] Another hypothesis suggests that the layering of 18 F-FDG in the urinary bladder is due to sedimentation of metabolically active cellular components such as inflammatory cells, malignant cells, or bacteria.[2],[3] In this case, there were neither symptoms nor clinical evidence that the patient had urinary tract infection. For 18 F-FDG PET/CT studies with intravenous iodinated contrast, the reversal of layering occurs where 18 F-FDG has layered anteriorly. This is due to the displacement of urine with 18 F-FDG by the urine-containing iodinated contrast.[4] The commonly seen fusion error due to urinary bladder filling changes is easily distinguishable from posterior layering of 18 F-FDG in the urinary bladder.[5] Knowledge of this phenomenon is important to avoid misinterpretation and unnecessary investigations. However, delayed imaging of the bladder would be the appropriate method for further clarification if bladder pathology is suspected.[6]

Acknowledgment

I would like to thank the Director-General of Health Malaysia for the permission to publish this paper.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


   Declaration of Patient Consent Top


The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.



 
   References Top

1.
Zeng W, Sepulveda JN, Nye J, Votaw JR, Nieh PT, Carew J, et al. Posterior bladder layering of excreted 18F-FDG on PET/CT. Nucl Med Commun 2010;31:859-63.  Back to cited text no. 1
    
2.
Kumar K. Settlement of [l8F]-FDG in the urinary bladder – A new sign. Nucl Med Commun 2009;30:37-40.  Back to cited text no. 2
    
3.
Shen G, Zhang W, Jia Z, Deng H. Interesting layering of excreted 18F-FDG in the urinary bladder in patients with urinary tract infection and distended bladder. J Nucl Med Technol 2015;43:234-5.  Back to cited text no. 3
    
4.
Purcell DD, Coakley FV, Franc BL, Hawkins RA, Boddington SE, Yeh BM, et al. Anterior layering of excreted 18F-FDG in the bladder on PET/CT: Frequency and cause. AJR Am J Roentgenol 2007;189:W96-9.  Back to cited text no. 4
    
5.
Heiba SI, Raphael B, Castellon I, Altinyay E, Sandella N, Rosen G, et al. PET/CT image fusion error due to urinary bladder filling changes: Consequence and correction. Ann Nucl Med 2009;23:739-44.  Back to cited text no. 5
    
6.
Anjos DA, Etchebehere EC, Ramos CD, Santos AO, Albertotti C, Camargo EE, et al. 18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer. J Nucl Med 2007;48:764-70.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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