A Closer Look at New Guidelines for Molecular Imaging of Renal Masses: An Interview with Steven Rowe, MD, Part 2

While the imaging agent ^99mTc-sestamibi has FDA-approved indications for myocardial perfusion and molecular breast imaging, Steven Rowe, MD, PhD, said off-label use of the modality offers a twofold utility for characterizing indeterminate renal masses.

In an interview with Diagnostic Imaging to discuss recently published guidelines on molecular imaging for renal masses, Dr. Rowe said the copious mitochondria on benign and indolent tumors lead to significant uptake of ^99mTc-sestamibi while malignant tumors quickly repel the mitochondrial imaging agent.

“It’s not that that the more aggressive cancers don't have mitochondria, but they have a set of proteins on their surfaces that are often referred to as multi-drug resistance pumps. … The most common types of aggressive renal cancers are derived from parts of the kidney called the distal tubules and the distal tubules have evolved (to) specifically get rid of small organic molecules, which ^99mTc-sestamibi is, so the cancers tend to spit it out as fast as it accumulates in them,” explained Dr. Rowe, a professor of radiology and director of human subjects research in radiology at the University of Texas Southwestern Medical Center in Dallas.

Noting that the renal mass is a “very heterogeneous and complex entity,” Dr. Rowe suggested that artificial intelligence (AI) may evolve to a point where it considers a variety of imaging data and clinical information to facilitate improved efficiency in clinical decision-making for indeterminate renal masses.

“Combining all of that together in a sort of a digestible way is not necessarily easy, or at least not easy for humans. I am hoping that's maybe where AI can pick up and run with this, to take all that information and provide a very sort of nuanced look at the patient's tumor and whether that tumor needs to be treated or whether it can be safely observed,” posited Dr. Rowe.

(Editor’s note: For related content, see “A Closer Look at New Guidelines for Molecular Imaging of Renal Masses: An Interview with Steven Rowe, MD, Part 1,” “Can CT-Based AI Radiomics Enhance Prediction of Recurrence-Free Survival for Non-Metastatic ccRCC?” and “Meta-Analysis Assesses Impact of PSMA PET/CT for Staging of Renal Cell Carcinoma.”)

For more insights from Dr. Rowe, watch the video below.