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

• We assessed the performance of FDG PET/CT in the detection of venous thromboembolism.
• The metabolic activity is significantly increased is deep vein thrombosis
• Increased metabolic activity is however insufficient to diagnose DVT in routine practice.

IntroductionThrombosis 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 methodsThe 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.ResultsOut 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.ConclusionsFDG PET/CT is not accurate enough for the diagnosis of VTE.