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Detection of pulmonary tumour thrombosis by integrated 18F-FDG PET/CT scans with intravenous contrast
Detección de trombosis tumoral pulmonar mediante imágenes integradas 18F-FDG PET/TC con contraste endovenoso
E. Valls, J.R. Garcia
, R. Rodriguez, M. Soler, M. Moragas, F. Lomeña
Corresponding author
Unidad PET/TC CETIR-ERESA, Esplugues, Barcelona, Spain
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"apellidos" => "Garcia" "email" => array:1 [ 0 => "jrgarcia@cetir.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Rodriguez" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Soler" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Moragas" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "Lomeña" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad PET/TC CETIR-ERESA, Esplugues, Barcelona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Detección de trombosis tumoral pulmonar mediante imágenes integradas <span class="elsevierStyleSup">18</span>F-FDG PET/TC con contraste endovenoso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2112 "Ancho" => 1585 "Tamanyo" => 202031 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET/CTeV images. Left hilar–infrahilar pulmonary mass of 71<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>64<span class="elsevierStyleHsp" style=""></span>mm in diameter, with spiculated and lobulated edges and heterogeneous uptake of the endovenous contrast and intense pathological uptake of <span class="elsevierStyleSup">18</span>F-FDG (SUVmax 7.5<span class="elsevierStyleHsp" style=""></span>ng/ml), with a central hypoactive area due to intratumoral fibrosis/necrosis compatible with a neoformative process. This mass produced partial stenosis of the bronchial of the lingula, and the most caudal portion is in wide contact with the left auricula and ventricle.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old male with a history of pulmonary adenocarcinoma in the upper right lobe underwent surgery in 2005 and was in complete remission. A CT performed in March 2010 showed a new, left pulmonary hilar mass and an endoscopic biopsy was carried out. The histological analysis indicated small cell lung cancer. The patient was referred to our centre for restaging.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A whole body PET/CT was performed 1<span class="elsevierStyleHsp" style=""></span>h after the administration of 296<span class="elsevierStyleHsp" style=""></span>MBq of <span class="elsevierStyleSup">18</span>F-FDG. Delayed images were also obtained in the thoracic region at 2<span class="elsevierStyleHsp" style=""></span>h postinjection, and were fused with the enhanced intravenous contrast CT images (PET/CTeV).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The PET/CT images showed a hypermetabolic left hilar–infrahilar mass causing partial stenosis of the bronchial of the lingula (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Delayed PET/CTeV images showed that the most caudal portion was in wide contact with the left auricula and ventricle and a repletion defect could also be observed in the interior of the upper left pulmonary vein coinciding with abnormal uptake of <span class="elsevierStyleSup">18</span>F-FDG. These characteristics are indicative of vascular tumour invasion by contiguity (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Likewise, a hypermetabolic focus was observed in the upper lobe of this lung, being persistent in the delayed phase and corresponding to a repletion defect in a venous structure in the enhanced contrast CT image. This morpho-metabolic behaviour was compatible with a tumour thrombus (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Venous thrombosis is a relatively frequent complication in patients with cancer and is an important cause of morbidity and mortality. The Virchow triad has been described among the factors favouring this entity involving: endothelial dysfunction, hypercoagulability and stasis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">However, the presence of tumour thrombi is a less frequent complication in solid tumours, although they have been reported in carcinoma of the colon, pancreas, liver and kidney and are even less frequent in lymphomas and sarcomas. Infiltration by contiguity of the inferior vena cava is the most frequent cause of distant thrombosis, followed by infiltration of the portal vein. The origin of thrombosis may or may not be tumour.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Few articles have been published on the diagnosis of tumour thrombus with <span class="elsevierStyleSup">18</span>F-FDG. Sharma et al. reported a significant difference in the uptake of <span class="elsevierStyleSup">18</span>F-FDG between benign and tumour thrombosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Davidson et al. concluded that the PET/CT may be useful in the diagnosis of tumour thrombus and in its differentiation with benign venous thrombi.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the present case we diagnosed a tumour thrombosis by contiguity in the upper left pulmonary vein in the PET/CTeV image on identifying the increased uptake of <span class="elsevierStyleSup">18</span>F-FDG as a repletion defect in the arterial phase of the CT.</p><p id="par0045" class="elsevierStylePara elsevierViewall">PET/CTeV is even more crucial in the case of distant lesions since it demonstrates how the hypermetabolic focus coincides with the presence of a tumour thrombus, thereby ruling out a parenchymatous pulmonary lesion.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-11-07" "fechaAceptado" => "2012-01-01" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Valls E, et al. Detección de trombosis tumoral pulmonar mediante imágenes integradas <span class="elsevierStyleSup">18</span>F-FDG PET/TC con contraste endovenoso. Rev Esp Med Nucl Imagen Mol. 2013;<span class="elsevierStyleBold">32</span>:49–51.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2112 "Ancho" => 1585 "Tamanyo" => 202031 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET/CTeV images. Left hilar–infrahilar pulmonary mass of 71<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>64<span class="elsevierStyleHsp" style=""></span>mm in diameter, with spiculated and lobulated edges and heterogeneous uptake of the endovenous contrast and intense pathological uptake of <span class="elsevierStyleSup">18</span>F-FDG (SUVmax 7.5<span class="elsevierStyleHsp" style=""></span>ng/ml), with a central hypoactive area due to intratumoral fibrosis/necrosis compatible with a neoformative process. This mass produced partial stenosis of the bronchial of the lingula, and the most caudal portion is in wide contact with the left auricula and ventricle.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1820 "Ancho" => 2918 "Tamanyo" => 383895 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PET/CTeV images. Repletion defect in the interior of the upper left pulmonary vein with augmented glucolytic activity (SUVmax 5.7) indicative of tumoral invasion by contiguity.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1773 "Ancho" => 2918 "Tamanyo" => 394292 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">PET/CTeV images. Morphologically hypodense tubular lesion observed after the administration of intravenous contrast in the upper left lung with metabolic activity (SUVmax 5.7) compatible with venous tumoral thrombus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignancies, prothrombotic mutations, and the risk of venous thrombosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.W. Blom" 1 => "C.J. Doggen" 2 => "S. Osanto" 3 => "F.R. Rosendaal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.293.6.715" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2005" "volumen" => "293" "paginaInicial" => "715" "paginaFinal" => "722" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15701913" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG PET-CT in the diagnosis of tumor thrombus: can it be differentiated from benign thrombus?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Sharma" 1 => "R. Kumar" 2 => "S. Jeph" 3 => "S. Karunanithi" 4 => "N. Naswa" 5 => "A. Gupta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MNM.0b013e32834774c8" "Revista" => array:6 [ "tituloSerie" => "Nucl Med Commun" "fecha" => "2011" "volumen" => "32" "paginaInicial" => "782" "paginaFinal" => "788" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21799368" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG-PET/CT for the diagnosis of tumor thrombosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Davidson" 1 => "O. Goitein" 2 => "A. Avigdor" 3 => "S.Z. Tzila" 4 => "E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 1 | 2 |
| 2022 July | 0 | 2 | 2 |
| 2018 May | 1 | 0 | 1 |
| 2018 February | 1 | 3 | 4 |
| 2018 January | 4 | 0 | 4 |
| 2017 December | 5 | 2 | 7 |
| 2017 November | 9 | 5 | 14 |
| 2017 October | 10 | 2 | 12 |
| 2017 September | 11 | 6 | 17 |
| 2017 August | 11 | 5 | 16 |
| 2017 July | 7 | 6 | 13 |
| 2017 June | 14 | 23 | 37 |
| 2017 May | 29 | 14 | 43 |
| 2017 April | 15 | 2 | 17 |
| 2017 March | 22 | 5 | 27 |
| 2017 February | 21 | 4 | 25 |
| 2017 January | 17 | 5 | 22 |
| 2016 December | 12 | 9 | 21 |
| 2016 November | 10 | 9 | 19 |
| 2016 October | 27 | 9 | 36 |
| 2016 September | 52 | 7 | 59 |
| 2016 August | 23 | 6 | 29 |
| 2016 July | 3 | 3 | 6 |
| 2016 June | 17 | 15 | 32 |
| 2016 May | 16 | 11 | 27 |
| 2016 April | 21 | 11 | 32 |
| 2016 March | 12 | 13 | 25 |
| 2016 February | 12 | 10 | 22 |
| 2016 January | 22 | 17 | 39 |
| 2015 December | 17 | 13 | 30 |
| 2015 November | 17 | 19 | 36 |
| 2015 October | 20 | 18 | 38 |
| 2015 September | 15 | 8 | 23 |
| 2015 August | 31 | 2 | 33 |
| 2015 July | 32 | 5 | 37 |
| 2015 June | 13 | 5 | 18 |
| 2015 May | 11 | 3 | 14 |
| 2015 April | 24 | 7 | 31 |
| 2015 March | 22 | 1 | 23 |
| 2015 February | 16 | 5 | 21 |
| 2015 January | 22 | 7 | 29 |
| 2014 December | 40 | 7 | 47 |
| 2014 November | 17 | 5 | 22 |
| 2014 October | 31 | 3 | 34 |
| 2014 September | 21 | 2 | 23 |
| 2014 August | 11 | 3 | 14 |
| 2014 July | 12 | 2 | 14 |
| 2014 June | 15 | 2 | 17 |
| 2014 May | 13 | 2 | 15 |
| 2014 April | 14 | 1 | 15 |
| 2014 March | 12 | 4 | 16 |
| 2014 February | 13 | 1 | 14 |
| 2014 January | 18 | 2 | 20 |
| 2013 July | 3 | 1 | 4 |
| 2013 June | 2 | 0 | 2 |
| 2013 May | 3 | 0 | 3 |
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