Sharma Punit, Kumar Rakesh, Jeph Sunil, Karunanithi Sellam, Naswa Niraj, Gupta Arun, Malhotra Arun
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
Nucl Med Commun. 2011 Sep;32(9):782-8. doi: 10.1097/MNM.0b013e32834774c8.
The correct diagnosis of tumor thrombosis and its differentiation from benign thrombus can change patient management and prevent unnecessary anticoagulation treatment. This study was aimed at evaluating the role of fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) in the diagnosis of tumor thrombosis, and its differentiation from benign thromboembolism.
We conducted a retrospective review of FDG PET-CT scans of patients who underwent the study for staging/restaging of a known malignancy and had FDG-avid thrombosis. Maximum standardized uptake value (SUV max) of the thrombus, SUV max of tumor (if any), and SUV max of mediastinal blood pool were calculated. PET-CT results were confirmed with clinical follow-up, structural imaging, and histopathology when available.
A total of 24 patients (15 male and nine female) with a mean age of 43.8 years (range: 3-72 years; median: 47.5 years) were evaluated. On the basis of structural imaging and clinical follow-up, 10 patients had benign and 14 patients had tumor thrombosis. On FDG PET-CT, uptake in the thrombus was linear in 18 patients and focal in six patients. The most common site of thrombosis was the inferior vena cava. The mean SUV max was 3.2 (range: 2.3-4.6; median: 3.3) in the benign thrombosis group and was 6.0 (range: 2.3-13.8; median: 3.3) in the tumor thrombosis group. The difference in SUV max was significant (P=0.013). On receiver operating characteristic analysis, a cut-off SUV max of 3.63 (sensitivity: 71.4% and specificity: 90%) was obtained to differentiate tumor thrombus from benign thromboembolism. In six patients, FDG PET-CT detected occult vascular thrombosis.
FDG PET-CT can detect active tumor thrombosis and is helpful in differentiating it from benign thrombus.
肿瘤血栓的正确诊断及其与良性血栓的鉴别能够改变患者的治疗方案，并避免不必要的抗凝治疗。本研究旨在评估氟脱氧葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）在肿瘤血栓诊断及其与良性血栓栓塞鉴别中的作用。
我们对因已知恶性肿瘤分期/再分期而接受研究且存在FDG摄取阳性血栓的患者的FDG PET-CT扫描进行了回顾性分析。计算血栓的最大标准化摄取值（SUV max）、肿瘤（如有）的SUV max以及纵隔血池的SUV max。PET-CT结果通过临床随访、结构成像以及必要时的组织病理学检查进行确认。
共评估了24例患者（15例男性和9例女性），平均年龄43.8岁（范围：3 - 72岁；中位数：47.5岁）。根据结构成像和临床随访，10例患者为良性血栓，14例患者为肿瘤血栓。在FDG PET-CT上，18例患者血栓摄取呈线性，6例患者呈局灶性。血栓最常见的部位是下腔静脉。良性血栓组的平均SUV max为3.2（范围：2.3 - 4.6；中位数：3.3），肿瘤血栓组为6.0（范围：2.3 - 13.8；中位数：3.3）。SUV max的差异具有统计学意义（P = 0.013）。在接受者操作特征分析中，得到区分肿瘤血栓与良性血栓栓塞的SUV max临界值为3.63（敏感性：71.4%，特异性：90%）。在6例患者中，FDG PET-CT检测到隐匿性血管血栓。
FDG PET-CT能够检测出活动性肿瘤血栓，并有助于将其与良性血栓相鉴别。
