Role of FDG PET-CT in Distinction of Benign Thrombus and Tumor Thrombus in Oncological Patients

Abstract

Aim: Accurate diagnosis of tumor thrombus and distinguishing benign thrombus from tumor thrombus avoid unnecessary anticoagulant treatment of oncological patients and it is important for patient management. In this retrospective study, we aimed to demonstrate the role of FDG-PET/CT imaging for distinction of benign thrombus from tumor thrombus.Materials and Methods: FDG-PET/CT imaging performed for staging, restaging and treatment response in oncological patients with thrombus were evaluated for accurate diagnosis of tumor thrombus and distinguishing benign thrombus from tumor thrombus by the examination of maximum standard uptake value (SUVmax). PET-CT imaging were evaluated both with visual assessment and increased metabolic activity. PET-CT findings were confirmed by clinical, radiological follow-up and biopsy in some cases.Results: PET-CT imaging findings of a total of 37 patients with suspected tumor thrombus (25 men, 12 women, mean age: 53.62-range: 8-82) were evaluated, retrospectively. Tumor thrombus in 11 segments in 8 patients (9 linear, 2 focal) and benign thrombus in 45 regions in the other 29 patients were reported in the evaluation of a total of 56 thrombi region in 37 patients on visual analysis and according to the increased metabolic activity. The most common region of thrombosis was defined as vena cava inferior. SUVmax values ranged from 7.91 to 20 (mean: 12.8) in 8 tumor thrombus patients. Compared to mediastinal region increased metabolic activity was not detected in none of the 29 patients with benign thrombus and these patients were treated with anticoagulant agents. Conclusion:As a conclusion, FDG PET-CT imaging may be useful in oncological patients when radiological imaging findings are suspicious for tumor thrombus.

Primary Gastric Rhabdomyosarcoma

“…FDG-PET/CT can help differentiate tumor thrombosis from VTE owing to its similar metabolic uptake to that of the tumor ( 13 ). Furthermore, the linear and focal FDG uptake patterns with a high maximum standardized uptake value (SUVmax) values in FDG-PET/CT may be useful ( 14 ). In the present case, a linear FDG uptake and high SUVmax (9.9) in the splenic vein were associated with tumor thrombosis.…”