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The role of 18F-FDG PET/CT in differentiating malignant from benign portal vein thrombosis

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Abstract

Aims

In this retrospective study, we evaluated the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in differentiating malignant from benign portal vein thrombosis (PVT) in patients with known malignant tumors.

Methods

Seventy-two patients with histologically or clinically confirmed PVT and who had undergone 18F-FDG PET/CT were included. Visual and semiquantitative analyses of PET/CT scans were performed. Metabolic activity was measured using the maximum standardized uptake value (SUVmax) by drawing the region of interest at the site of thrombosis. Receiver operating characteristic analysis was conducted to identify the optimal cutoff of SUVmax for detecting neoplastic thrombosis. Malignancy was defined using the following criteria: (1) visual analysis and (2) SUVmax >3.35. PET/CT results were confirmed with histopathological results and clinical and imaging follow-up.

Results

The SUVmax of tumor thrombus (6.37 ± 2.67) was significantly higher than that of bland thrombus (2.87 ± 1.47; P < 0.01). The sensitivities, specificities, and accuracies for the two criteria were 91.5 % and 93.6; 64.0 and 80.0 %; and 81.9 % and 88.9 %, respectively.

Conclusion

18F-FDG PET/CT is a promising new method for distinguishing between portal venous neoplastic thrombosis and bland thrombosis using semiquantitative analysis, with the optimal cutoff value of SUVmax >3.35 as a criterion.

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References

  1. Sotiropoulos GC, Radtke A, Schmitz KJ, et al. (2008) Liver transplantation in the setting of hepatocellular carcinoma and portal vein thrombosis: a challenging dilemma? Dig Dis Sci 53(7):1994–1999

    Article  PubMed  Google Scholar 

  2. Sizemore AW, Jacobs MP, Mantil JC, Hahm GK (2007) FDG uptake in inferior vena cava tumor thrombus from renal cell carcinoma on positron emission tomography. Clin Nucl Med 32(4):309–311

    Article  PubMed  Google Scholar 

  3. Gupta P, Kramer EL, Ponzo F (2005) FDG uptake in tumor thrombus in inferior vena cava from rectal cancer on positron emission tomography. Clin Nucl Med 30(5):342–343

    Article  PubMed  Google Scholar 

  4. Kaida H, Ishibashi M, Kurata S, Uchida M, Hayabuchi N (2007) Tumor thrombus in the inferior vena cava from colon cancer detected by 18F-FDG–PET. Ann Nucl Med 21:185–188

    Article  PubMed  Google Scholar 

  5. Nguyen BD (2005) Pancreatic neuroendocrine tumor with portal vein tumor thrombus: PET demonstration. Clin Nucl Med. 30:628–629

    Article  PubMed  Google Scholar 

  6. Kurtovic J, Van Der Wall H, Riordan SM (2005) FDG PET for discrimination between tumor extension and blood thrombus as a cause for portal vein thrombosis in hepatocellular carcinoma: important role in exclusion of transplant candidacy. Clin Nucl Med 30(6):408–410

    Article  PubMed  Google Scholar 

  7. Hanajiri K, Mitsui H, Maruyama T, et al. (2005) 18F-FDG PET for hepatocellular carcinoma presenting with portal vein tumor thrombus. J Gastroenterol 40:1005–1006

    Article  PubMed  Google Scholar 

  8. Tateishi U, Yamaguchi U, Terauchi T, et al. (2005) Extraskeletal osteosarcoma: extensive tumor thrombus on fused PET–CT images. Ann Nucl Med 19(8):729–732

    Article  PubMed  Google Scholar 

  9. Strobel K, Steinert HC, Bhure U, et al. (2007) Tumour thrombus in the superior vena cava from anaplastic carcinoma of the thyroid: FDG–PET/CT imaging findings. Eur J Nucl Med Mol Imaging 34:813

    Article  CAS  PubMed  Google Scholar 

  10. Lai P, Bomanji JB, Mahmood S, et al. (2007) Detection of tumour thrombus by 18F FDG–PET/CT imaging. Eur J Cancer Prev 16:90–94

    Article  CAS  PubMed  Google Scholar 

  11. Davidson T, Goitein O, Avigdor A, Zwas ST, Goshen E (2009) 18F-FDG–PET/CT for the diagnosis of tumor thrombosis. Isr Med Assoc J 11:69Y73

    Google Scholar 

  12. Sharma P, Kumar R, Jeph S, et al. (2011) 18F-FDG PET–CT in the diagnosis of tumor thrombus: can it be differentiated from benign thrombus? Nucl Med Commun 32:782–788

    Article  PubMed  Google Scholar 

  13. Lee EY, Khong PL (2013) The value of 18F-FDG PET/contrast-enhanced CT in detection of tumor thrombus. Clin Nucl Med 38(2):60–65

    Article  Google Scholar 

  14. Sun L, Guan YS, Pan WM, et al. (2008) Highly metabolic thrombus of the portal vein: 18F fluorodeoxyglucose positron emission tomography/computer tomography demonstration and clinical significance in hepatocellular carcinoma. World J Gastroenterol 14(8):1212–1217

    Article  PubMed Central  PubMed  Google Scholar 

  15. Connolly GC, Chen R, Hyrien O, et al. (2008) Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res 122(3):299–306

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Takizawa D, Kakizaki S, Sohara N, et al. (2007) Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis. Dig Dis Sci 52:3290–3295

    Article  PubMed  Google Scholar 

  17. Alswat KA, Sanai FM, Altuwaijri M, et al. (2013) Clinical characteristics of patients with hepatocellular carcinoma in a middle eastern population. Hepat Mon 13(5):e7612

    Article  PubMed Central  PubMed  Google Scholar 

  18. Kaufman LB, Yeh BM, Breiman RS, et al. (2005) Inferior vena cava filling defects on CT and MRI. Am J Roentgenol 185:717–726

    Article  Google Scholar 

  19. Aslam Sohaib SA, Teh J, Nargund VH, et al. (2002) Assessment of tumor invasion of the vena caval wall in renal cell carcinoma cases by magnetic resonance imaging. J Urol 167:1271–1275

    Article  CAS  PubMed  Google Scholar 

  20. Ergen FB, Hussain HK, Caoili EM, et al. (2004) MRI for preoperative staging of renal cell carcinoma using the 1997 TNM classification: comparison with surgical and pathologic staging. Am J Roentgenol 182:217–225

    Article  Google Scholar 

  21. Spritzer CE, Trotter P, Sostman HD (1998) Deep venous thrombosis: gradient-recalled-echo MR imaging changes over time—experience in 10 patients. Radiology 208(3):631–639

    Article  CAS  PubMed  Google Scholar 

  22. Aurangabadkar HU, Palle L, Ali Z (2013) Tumour thrombosis and patterns of fluorine-18 fluorodeoxyglucose uptake: a pictorial review. Nucl Med Commun 34:627–637

    Article  CAS  PubMed  Google Scholar 

  23. Ichiki M, Sakai Y, Nango M, et al. (2012) Experimental venous thrombi: MRI characteristics with histopathological correlation. Br J Radiol 85(1012):331–338

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Zhuang H, Alavi A (2002) 18-Fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation. Semin Nucl Med 32(1):47–59

    Article  PubMed  Google Scholar 

  25. Do B, Mari C, Biswal S, et al. (2006) Diagnosis of aseptic deep venous thrombosis of the upper extremity in a cancer patient using F-18 FDG PET/CT. Ann Nucl Med 20:151–155

    Article  CAS  PubMed  Google Scholar 

  26. Miceli M, Atoui R, Walker R, et al. (2004) Diagnosis of deep septic thrombophlebitis in cancer patients by F-18 FDG positron emission tomography scanning: a preliminary report. J Clin Oncol 22:1949–1956

    Article  PubMed  Google Scholar 

  27. Probst S, Seltzer A, Chachoua A, Friedman K (2010) Azygos venous tumor thrombus from renal cell carcinoma detected by F-18 FDG PET/CT. Clin Nucl Med. 35:832–833

    Article  PubMed  Google Scholar 

  28. Ozülker T, Ozülker F, Eker O, Ozpaçaci T, Ozcan D (2009) Tumour thrombus from follicular thyroid cancer detected by 18F-FDG–PET/CT. Hell J Nucl Med 12:66–67

    PubMed  Google Scholar 

  29. Sun L, Wu H, Pan W-M, Guan Y-S (2007) Positron emission tomography/computed tomography with (18)F-fluorodeoxyglucose identifies tumor growth or thrombosis in the portal vein with hepatocellular carcinoma. World J Gastroenterol 13:4529–4532

    PubMed  Google Scholar 

  30. Shimoda M, Iso Y, Tomita S, et al. (2008) Middle bile duct cancer with portal vein tumor thrombus. World J Surg Oncol 6:48

    Article  PubMed Central  PubMed  Google Scholar 

  31. Beadsmoore J, Cheow K, Sala E, et al. (2005) Hepatocellular carcinoma tumor thrombus in a re-canalised para-umbilical vein: detection by 18-fluoro-2-deoxyglucose positron emission tomography imaging. Br J Radiol 78:841–844

    Article  CAS  PubMed  Google Scholar 

  32. Kikuchi M, Yamamoto E, Shiomi Y, et al. (2004) Internal and external jugular vein thrombosis with marked accumulation of FDG. Br J Radiol 77:888–890

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the National Nature Science Foundation of China, No. 81170435 and the Shanghai Leading Talent Team Construction Special Funds, No. 2011-036.

Conflict of interest

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Changhai Hospital of Second Military Medical University, 168 Changhai Road, YangPu, Shanghai, 200433, China

    Shengping Hu, Jian Zhang, Chao Cheng, Qinghua Liu, Gaofeng Sun & Changjing Zuo

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  1. Shengping Hu
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  2. Jian Zhang
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  3. Chao Cheng
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  4. Qinghua Liu
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  5. Gaofeng Sun
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  6. Changjing Zuo
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Corresponding author

Correspondence to Changjing Zuo.

Additional information

Each author had participated sufficiently in the study. Publication is approved by all authors, the work was carried out in Shanghai Changhai Hospital.

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Hu, S., Zhang, J., Cheng, C. et al. The role of 18F-FDG PET/CT in differentiating malignant from benign portal vein thrombosis. Abdom Imaging 39, 1221–1227 (2014). https://doi.org/10.1007/s00261-014-0170-5

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  • DOI: https://doi.org/10.1007/s00261-014-0170-5

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