FDG-PET/CT in venous thromboembolism

Abstract

Purpose: Venous thromboembolism (VTE) is common; deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most common presentations. VTE may arise in the entire venous bed and the diagnosis may be difficult. VTE is a dynamic disease, inflammation is key, and FDG-PET/CT has been proposed, e.g. to detect thrombi in any anatomic location, to differentiate acute from chronic VTE, and to differentiate bland VTE from tumor thrombosis. The aim of this systematic review was to assess if the potential uses of 18 F-Fluorodeoxyglucose positron emission tomography/computer tomography (FDG-PET/CT) in VTE are described and documented in the literature. Methods: PubMed and Embase databases were searched. Duplicates and papers in other languages than English and Scandinavian were removed. Remaining papers were screened by title and abstract. Eligible papers were assessed in full-text. Results: The master search yielded 3,897 hits, 316 papers were eligible for full-text assessment. Ten papers were included; six on diagnostic performance of PET/CT in VTE, and four on the ability of PET/CT to differentiate bland VTE from tumor thrombosis. Three papers were prospective, seven were retrospective. Conclusion: If applied early, FDG-PET/CT may have a role in diagnosing DVT, but not PE, to discriminate acute from chronic VTE, and to demonstrate recurrent VTE. FDG-PET/CT is by some considered adept in differentiating bland VTE from tumor thrombosis, but we find this controversial due to FDG avidity in bland VTE. FDG-PET/CT may be feasible when screening for occult malignancy. However, in all mentioned areas, available literature is too sparse and too heterogeneous to allow firm conclusions.

(The Role of PET/CT in Angiology)

“…Na genezi žilního trombu se zejména v iniciální fázi podílejí zánětlivé procesy, z buněčných elementů je časně možné detekovat infi ltraci neutrofi ly a makrofágy. 46,47 Je tedy možné očekávat, že by v určitém aspektu mohla FDG PET k diagnostice HŽT, popř. PE přispět.…”

“…Literatury analyzující možnosti FDG PET u tromboembolické nemoci je malé množství. Z hlediska diagnostiky, potažmo lokalizace HŽT studie ukazují, že FDG PET/ CT může lokalizovat HŽT v časné fázi s relativně vysokou senzitivitou i specifi citou přesahující 80 %, [46][47][48] pokud je použito v krátkém odstupu od vzniku příznaků. Zvýšená akumulace FDG v trombu, popř.…”

“…S použitím této premisy lze pomocí FDG PET/CT odlišit nádorový trombus se senzitivitou 71-100 % a specifi citou 64-100 %. 47 Dané práce však v řadě případů nemají histologický referenční standard a z pohledu časové dynamiky akumulace v trombu diskutované výše je zřejmé, že prostý trombus, který v časné fázi hyperakumuluje FDG, nelze od nádorového spolehlivě rozeznat (viz obr. 6B a 8B).…”

“…Cenná je především vysoká negativní prediktivní hodnota vyšetření, problematický je výskyt falešně pozitivních nálezů indukujících další vyšetřovací procedury. 47…”

An update on the unparalleled impact of FDG-PET imaging on the day-to-day practice of medicine with emphasis on management of infectious/inflammatory disorders

“…Similarly, imaging with FDG (right) has been another major step forward by enhancing the role of medical imaging and this has led to an unparalleled impact on both research and patient care disclose this; and differentiating acute from chronic VTE is impossible by routine imaging, but has profound influence on treatment strategy. A recent systematic review has summarized the potential within all of the mentioned domains, but the literature is still too sparse for firm conclusions [116].…”