Introduction:Radiotracer-based nuclear imaging, including positron emission tomography (PET) and single-photon emission computed tomography (SPECT), can complement conventional cross-sectional imaging in renal cell carcinoma (RCC) by providing biological characterisation of tumour metabolism, angiogenesis, hypoxia, and the tumour microenvironment. While computed tomography (CT) and magnetic resonance imaging (MRI) remain the diagnostic standard, accumulating evidence suggests that selected nuclear imaging techniques may offer incremental value in specific clinical scenarios.Methods:A narrative literature review was performed using PubMed, Embase, and Web of Science to identify preclinical, retrospective, and prospective studies evaluating PET and SPECT radiotracers in localised and metastatic RCC. Priority was given to meta-analyses, multicentre prospective trials, and studies with histopathological correlation.Results:[18F]fluorodeoxyglucose (FDG) PET/CT demonstrates limited sensitivity for primary renal tumours (pooled sensitivity of approximately 60%) but performs substantially better in metastatic and recurrent disease (pooled sensitivity and specificity of approximately 85–90%), where uptake correlates with tumour grade, progression-free survival, and overall survival. [99mTc]sestamibi SPECT/CT differentiates oncocytoma and hybrid oncocytic/chromophobe tumours from malignant RCC with pooled sensitivity and specificity of around 85–90%, supporting its role in evaluating indeterminate renal masses rather than staging. Prostate-specific membrane antigen (PSMA) PET/CT shows high detection rates in clear-cell RCC, particularly in metastatic disease, with reported sensitivities of approximately 85–90% and management changes in up to 40–50% of selected cohorts. Carbonic anhydrase IX (CAIX)-targeted PET/CT enables the biologically specific visualisation of clear-cell RCC, achieving sensitivities and specificities in the range of 85–90% in prospective phase II and III trials for primary tumour characterisation. Fibroblast activation protein inhibitor (FAPI) PET/CT demonstrates high tumour-to-background uptake in early RCC studies, but evidence remains preliminary, with small cohorts and recognised non-specific uptake in benign inflammatory and fibrotic conditions.Conclusions:Radiotracer-based nuclear imaging provides complementary, biology-driven insights in RCC that extend beyond anatomical assessment. While most modalities remain adjunctive or investigational and are not recommended for routine use, selective application in carefully chosen clinical scenarios may enhance tumour characterisation, prognostication, and personalised treatment planning.
引言：基于放射性示踪剂的核医学成像技术，包括正电子发射断层扫描（PET）和单光子发射计算机断层扫描（SPECT），能够通过提供肿瘤代谢、血管生成、缺氧状态及肿瘤微环境的生物学特征，在肾细胞癌（RCC）诊疗中补充传统横断面成像的不足。尽管计算机断层扫描（CT）和磁共振成像（MRI）仍是诊断标准，但越来越多的证据表明，在特定临床场景中，部分核医学成像技术可能提供额外的价值。
方法：通过PubMed、Embase和Web of Science数据库进行叙述性文献综述，筛选评估PET与SPECT放射性示踪剂在局限性和转移性RCC中应用的临床前研究、回顾性研究及前瞻性研究。优先纳入荟萃分析、多中心前瞻性试验以及具有组织病理学关联的研究。
结果：[18F]氟代脱氧葡萄糖（FDG）PET/CT对原发肾肿瘤的敏感性有限（汇总敏感性约60%），但在转移性和复发性疾病中表现显著更优（汇总敏感性和特异性约85–90%），其摄取程度与肿瘤分级、无进展生存期和总生存期相关。[99mTc]甲氧异丁基异腈（sestamibi）SPECT/CT能够区分嗜酸细胞瘤和混合性嗜酸细胞/嫌色细胞肿瘤与恶性RCC，汇总敏感性和特异性约为85–90%，支持其在评估性质不确定的肾脏肿块而非分期中的应用价值。前列腺特异性膜抗原（PSMA）PET/CT在透明细胞肾细胞癌中显示出高检出率，尤其在转移性疾病中，报告的敏感性约为85–90%，并在高达40–50%的选定队列中改变了治疗方案。碳酸酐酶IX（CAIX）靶向PET/CT能够实现透明细胞肾细胞癌的特异性生物学可视化，在前瞻性II期和III期试验中，其对原发肿瘤特征鉴别的敏感性和特异性达到85–90%的范围。成纤维细胞活化蛋白抑制剂（FAPI）PET/CT在早期RCC研究中显示出高肿瘤背景摄取比，但现有证据仍属初步，样本量较小，且已知在良性炎症和纤维化病变中存在非特异性摄取。
结论：基于放射性示踪剂的核医学成像可为肾细胞癌提供超越解剖学评估的、生物学驱动的补充性信息。尽管多数技术目前仍作为辅助或研究性手段，不推荐常规使用，但在精心选择的临床场景中有选择地应用，可能有助于优化肿瘤特征分析、预后评估及个体化治疗规划。
Nuclear Imaging in Renal Cell Carcinoma: Current Evidence and Clinical Applications
肿瘤(癌症)患者之家