Kollberg et al [98] prospectively assessed 103 patients with high-risk MIBC who underwent FDG-PET/CT in addition to CT and found that FDG-PET/CT led to an altered provisional treatment plan in 27% of patients. Similarly, a study by Mertens et al [99] of 96 consecutive patients with bladder cancer found that FDG-PET/CT provided additional staging information that modified the treatment of MIBC in almost 20% of cases. Voskuhl et al [100] evaluated the incremental benefit of FDG-PET/CT after standard conventional staging with a retrospective analysis of 711 consecutive patients having MIBC and found that FDG-PET/CT potentially influenced the treatment of almost one-fifth of patients, similar to the study by Mertens et al [99]. Bertolaso et al [101] assessed the accuracy of FDG-PET/CT for lymph node staging and found that treatment decisions were altered according to FDG-PET/CT results in almost a quarter of patients with MIBC. Currently, 11C-choline PET is primarily an experimental imaging modality. When compared with CT, it shows promise for increased accuracy in lymph node staging and may help avoid false-positive results for lymph nodes due to reactive hyperplasia [102]. According to current literature, 11C-choline PET/CT has a sensitivity of 42% to 59% and a specificity of 84% to 90% in detecting nodal disease [103,104]. In a study by Golan et al [105], 11C- choline PET/CT was compared with FDG-PET/CT in 20 consecutive patients with bladder cancer, with a total of 51 lesions. The PPVs for all detected lesions were 85% for 11C-choline PET/CT and 91% for FDG-PET/CT. The corresponding PPVs for extravesical lesions were 79% and 88%, respectively. FDG-PET/CT correctly identified 4 extravesical metastases missed by 11C-choline PET/CT. They concluded that 11C-choline PET/CT did not offer any advantage over FDG-PET/CT in detecting distant metastasis in bladder cancer.
Pretreatment Staging of Urothelial Cancer. Kollberg et al [98] prospectively assessed 103 patients with high-risk MIBC who underwent FDG-PET/CT in addition to CT and found that FDG-PET/CT led to an altered provisional treatment plan in 27% of patients. Similarly, a study by Mertens et al [99] of 96 consecutive patients with bladder cancer found that FDG-PET/CT provided additional staging information that modified the treatment of MIBC in almost 20% of cases. Voskuhl et al [100] evaluated the incremental benefit of FDG-PET/CT after standard conventional staging with a retrospective analysis of 711 consecutive patients having MIBC and found that FDG-PET/CT potentially influenced the treatment of almost one-fifth of patients, similar to the study by Mertens et al [99]. Bertolaso et al [101] assessed the accuracy of FDG-PET/CT for lymph node staging and found that treatment decisions were altered according to FDG-PET/CT results in almost a quarter of patients with MIBC. Currently, 11C-choline PET is primarily an experimental imaging modality. When compared with CT, it shows promise for increased accuracy in lymph node staging and may help avoid false-positive results for lymph nodes due to reactive hyperplasia [102]. According to current literature, 11C-choline PET/CT has a sensitivity of 42% to 59% and a specificity of 84% to 90% in detecting nodal disease [103,104]. In a study by Golan et al [105], 11C- choline PET/CT was compared with FDG-PET/CT in 20 consecutive patients with bladder cancer, with a total of 51 lesions. The PPVs for all detected lesions were 85% for 11C-choline PET/CT and 91% for FDG-PET/CT. The corresponding PPVs for extravesical lesions were 79% and 88%, respectively. FDG-PET/CT correctly identified 4 extravesical metastases missed by 11C-choline PET/CT. They concluded that 11C-choline PET/CT did not offer any advantage over FDG-PET/CT in detecting distant metastasis in bladder cancer.