18F氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描在静脉血栓栓塞症诊断中的应用

Performance of 18F fluoro-2-désoxy-D-glucose positron emission tomography/computed tomography for the diagnosis of venous thromboembolism.

作者信息

Le Roux Pierre-Yves, Robin Philippe, Delluc Aurélien, Tardy Bernard, Abgral Ronan, Couturaud Francis, Reffad Abdelmalek, Le Gal Grégoire, Salaun Pierre-Yves

机构信息

Université Européenne de Bretagne, Brest, France; Université de Brest, EA3878 (GETBO) IFR 148, Brest, France; CHRU de la Cavale Blanche, Service de médecine nucléaire, Boulevard Tanguy Prigent, 29609 Brest cedex, France.

出版信息

Thromb Res. 2015 Jan;135(1):31-5. doi: 10.1016/j.thromres.2014.10.008. Epub 2014 Oct 20.

DOI:10.1016/j.thromres.2014.10.008

PMID:25455997

Abstract

INTRODUCTION

Thrombosis and inflammation are intimately linked. Inflammatory component of venous thromboembolism (VTE) may allow the use of FDG positron emission tomography / computed tomography (FDG PET/CT) in the detection of thrombotic process. Published studies remain limited and contradictory. We aimed at evaluating the performance of FDG PET/CT in the detection of VTE in a population of patients enrolled in a prospective study evaluating FDG PET/CT for cancer screening in etiological assessment of idiopathic VTE.

MATERIALS AND METHODS

The first consecutive 100 patients who underwent FDG PET/CT were included. Visual and quantitative analyses of vascular axes was performed and compared with lower limb veins compression ultrasonography, lung scintigraphy and/or computed tomography pulmonary angiography.

RESULTS

Out of the 100 patients, 63 presented lobar pulmonary embolism for a total of 217 embolic sites and 62 had a deep vein thrombosis for a total of 143 thrombotic sites. Regarding pulmonary embolism, sensitivity and specificity of FDG PET/CT were 3% (95%CI: 1-6%) and 99% (95%CI: 98-100%). SUV max ratio between pulmonary embolism location and non-pathological contralateral vessel was 1.04±0.18 (p=0.7). Regarding deep vein thrombosis, sensitivity and specificity were 31% (95%CI: 24-39%) and 88% (95%CI: 81-92%). The metabolic activity was significantly higher than in contralateral vessels (p<0.001), with a SUV max ratio of 1.25±0.53, but without any significant SUVmax threshold applicable in routine practice for deep vein thrombosis diagnosis.

CONCLUSIONS

FDG PET/CT is not accurate enough for the diagnosis of VTE.

摘要

引言

血栓形成与炎症密切相关。静脉血栓栓塞症（VTE）的炎症成分可能使氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）可用于检测血栓形成过程。已发表的研究仍然有限且相互矛盾。我们旨在评估FDG PET/CT在一项前瞻性研究中的患者群体中检测VTE的性能，该研究评估FDG PET/CT用于癌症筛查以及特发性VTE的病因评估。

材料与方法

纳入连续接受FDG PET/CT检查的首批100例患者。对血管轴进行视觉和定量分析，并与下肢静脉压迫超声、肺闪烁扫描和/或计算机断层扫描肺动脉造影进行比较。

结果

100例患者中，63例出现肺叶肺栓塞，共217个栓塞部位，62例有深静脉血栓形成，共143个血栓形成部位。对于肺栓塞，FDG PET/CT的敏感性和特异性分别为3%（95%CI：1 - 6%）和99%（95%CI：98 - 100%）。肺栓塞部位与对侧非病变血管之间的SUV最大值比值为1.04±0.18（p = 0.7）。对于深静脉血栓形成，敏感性和特异性分别为31%（95%CI：24 - 39%）和88%（95%CI：81 - 92%）。代谢活性明显高于对侧血管（p < 0.001），SUV最大值比值为1.25±0.53，但在深静脉血栓形成诊断的常规实践中没有任何适用的显著SUV最大值阈值。