Advancements in Teleradiology and Radiotherapy

Renal anomalies may be seen and detected in all age groups, as an insidentally finding. We report the FDG PET/CT and 68 Ga PSMA findings in cancer patients with renal anomalies and situs inversus totalis in three patients.

Keywords

Renal anomalies, PET/CT, FDG, 68Ga-PSMA

Figure 1: An 65-year-old man with suspicious gastrointestinal system malignancy, underwent PET-CT imaging for metabolic characterization and primary lesion. Following a 4 hour fasting, while the patient had a blood glucose level of 152 mg/dL, 303 MBq (8.2 mCi) 18F-FDG was given i.v. after 60 min, images were taken from the calvarium to the soles of the feet in 3D mode to be 1 min per bed. PET-CT imaging demonstrated a subcarinal 1 cm lymphadenopaty (SUVmax: 10.42) and paraosephageal metastatic lympadenopaty (12x22 mm/ SUVmax: 20.68) at mediastinal region. In addition, an 32x26 mm mass compatible with primary malignancy (SUVmax: 20.14) was detected anteromedial section of gallbladder. An approximately 8x9 cm hypermetabolic mass was detected at pelvic region located cranial and posterior of the bladder. CT component of the PET-CT imaging demonstrated that this mass belonging to a pelvic cake kidney. Both kidneys were not located at normal localisation site. The patient was diagnosed as Klatskin tumor finallay.

Figure 2: PET-CT imaging normal variants, benign conditions and renal anomalies was reported in literature.1‒5 In this report, it was noticed that pelvic cake kidney is a rare renal anomaly and may result confusion.

Figure 3: An 62-year-old man with prostate cancer (Gleason skor: 4+5) underwent 68 Ga PET-CT imaging for suspected recurrence. The patient had radical prostatectomy operation history, progresive total PSA level. Total PSA level was 1.2 ng/ml (4.1 reference level) during imaging. Following iv. injection of 148 MBq (4 mCi) 68 Ga- PSMA, images were taken from the calvarium to the upper leg in 3D mode to be 1 min per bed 60 min. later. PET-CT imaging demonstrated right internal iliak 1.5cm metastatic lymph node (SUVmax: 26.95) In addition, an ectopic pelvic right kidney was detected with rotation anomaly. CT component of the PET-CT imaging demonstrated that this dense uptake was belonging to a kidney. Left kidney was located at normal localisation site.

Figure 4: An 63 years of women patient with posterior pharyngeal tumor underwent FDG PET-CT imaging for staging. Primary tumor (SUVmax:23.59) and cervical metastatic lymph nodes (SUVmax:11.84) were demontrates with white arrows. Additionally, the patient had situs inversus totalis anomaly detected insidentally. Myocardium, liver and spleen localisation sites were demonstrated with red arrows.

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Authors declare that there is no conflict of interest.

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