50 year old male with carcinoma urinary bladder. Underwent TURBT. Follow up PET CT showed focal FDG uptake in the right kidney. In view of the increased FDG uptake possibility of malignancy was raised and was referred for further evaluation with contrast MRI.
The coronal fused PET CT (A) and corresponding coronal CECT image (B) showing the focal area of FDG uptake in the mid pole of right kidney ( arrow) and no discernable abnormality/mass on CECT.
(A) Coronal T2W shows altered intensity predominantly hypointense wedge-shaped area in the mid pole cortex of the right kidney (arrow) corresponding to the area of increased FDG uptake on corresponding PET images. It shows restricted diffusion appearing hyperintense on the high b-value diffusion (C)and hypointense on corresponding ADC maps (B). This geographical area was relatively less enhanced compared to the normal parenchyma seen on axial post-contrast VIBE image (E) and coronal post-contrast VIBE (F). Multiple similar appearing areas with restricted diffusion were seen in both kidneys prominent in the lower pole of the left kidney (arrowhead) and the areas in the right kidney correlated with the areas of FDG uptake on PET CT. On Contrast MRI, these areas were wedge-shaped with no significant post-contrast enhancement and MR morphology was more in favor of focal pyelonephritis rather than neoplasia.
This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).
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