Tumor Thrombus Ancillary Findings on FDG PET/CT in an Oncologic Population

Purpose: Thrombosis in cancer may manifest itself as venous thromboembolic disease or tumor thrombosis (TT). We present our experience with incidentally detected TT on FDG PET/CT in 21 oncologic patients. Patients and Methods: We retrospectively reviewed all FDG PET/CT examinations during a 5-year period at the Army Hospital Research and Referral in New Delhi, India, and included all oncology cases with FDG-avid thrombosis in the report. The diagnosis of TT was based on FDG-avid solid masses inside the vessels in patients with known malignancy. The SUVmax was calculated. Results: Twenty-one patients were included; the most common malignancies were renal cell carcinoma (n = 6), hepatocellular carcinoma (n = 3), and lung cancer (n = 3). Indication for the scan was initial staging (n = 15) and suspected recurrence (n = 6). Several vessels were affected, the most common was the inferior vena cava (n = 14), but most other major branches of the venous vasculature was represented, and some patients had thrombi in several vessels. FDG uptake was linear in 7 patients, linear with a dilated vessel in 6 patients, and focal in 7 patients. The mean SUVmax of the primary tumors was 10.3 (range, 2.6-31.2; median, 6.9), and the mean SUVmax of the thrombi was 7.85 (range, 1.7-23.2; median, 6.1). All but 2 patients had additional FDG-avid foci besides the thrombus. Conclusions: This study supports results from other smaller studies regarding the usefulness of FDG PET/CT in TT and corroborates the hypothesis that the SUVmax and the patterns of FDG uptake can be helpful for differentiating BT from TT in oncological patients.