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18F-FDG PET in the Evaluation of Acuity of Deep Vein Thrombosis

Rondina, Matthew T. MD*†; Lam, Uyen T. BS; Pendleton, Robert C. MD*; Kraiss, Larry W. MD§; Wanner, Nathan MD*; Zimmerman, Guy A. MD†¶; Hoffman, John M. MD∥**††; Hanrahan, Christopher MD, PhD††; Boucher, Kenneth PhD∥**; Christian, Paul E. BS, CNMT; Butterfield, Regan I. BS, CNMT; Morton, Kathryn A. MD††

doi: 10.1097/RLU.0b013e3182638934
Original Articles

Purpose: 18F-FDG PET has been used for vascular disease, but its role in deep vein thrombosis (DVT) remains prospectively unexplored.

Patients and Methods: Whole-body 18F-FDG PET/CT scans were performed in patients 1 to 10 weeks after onset of symptomatic DVT (n = 12) and in control subjects without DVT (n = 24). The metabolic activity (SUVmax) of thrombosed and contralateral nonthrombosed vein segments was determined. The sensitivity and specificity of 18F-FDG PET/CT for the diagnosis of DVT were determined by receiver operating characteristic curve analyses. In 2 patients with DVT, changes in the metabolic activity of thrombosed vein segments in serial 18F-FDG PET scans.

Results: The metabolic activity in thrombosed veins [SUVmax, 2.41 (0.75)] was visually appreciable and significantly higher than in nonthrombosed veins in either the contralateral extremity of patients with DVT [SUVmax, 1.09 (0.25), P = 0.007] or control subjects [1.21 (0.22), P < 0.001]. The area under the receiver operating characteristic curve for SUVmax was 0.9773 (P < 0.001), indicating excellent accuracy. An SUVmax threshold of greater than 1.645 was 87.5% sensitive and 100% specific for DVT. Metabolic activity in thrombosed veins correlated significantly with time from DVT symptom onset (decrease in SUVmax of 0.02/d, P < 0.05). Best-fit-line analyses suggested that approximately 84 to 91 days after acute DVT, the maximum metabolic activity of thrombosed veins would return to normal levels.

Conclusions: 18F-FDG PET/CT is accurate for detecting acute symptomatic, proximal DVT. Metabolic activity in thrombosed veins decreases with time, suggesting that 18F-FDG PET may be helpful in assessing the age of the clot.

From the *Division of General Internal Medicine, Department of Internal Medicine, †Program in Human Molecular Biology and Genetics, ‡School of Medicine, §Division of Vascular Surgery, ¶Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, ∥Huntsman Cancer Institute, and Departments of **Oncological Sciences and ††Radiology, University of Utah, Salt Lake City, UT.

Received for publication February 16, 2012; revision accepted April 23, 2012.

Conflicts of interest and source of funding: This work was directly or indirectly supported by the National Institutes of Health (NIH) and the University of Utah CCTS (grant numbers 1R01CA121003, 1K23HL092161, 5R01HL092746, 5R01HL091754, and UL1RR025764). This project was also facilitated by the Huntsman Cancer Institute through its Molecular Imaging Research Program and by grant R01CA135556 from the National Cancer Institute/NIH, by a Cancer Center Support Grant from the National Cancer Institute/NIH (3P30CA042014), and by the Huntsman Cancer Foundation. Identifier: NCT 01107327.

Reprints: Kathryn A. Morton, MD, Department of Radiology, University of Utah, 50 N Medical Dr, Room 1A71, Salt Lake City, UT 84132. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.