FDG-PET/CT in venous thromboembolism

Venous thromboembolism (VTE) is common; deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most common presentations. VTE may arise from anywhere in the entire venous bed and the diagnosis may be difficult. VTE is a dynamic disease, inflammation is key, and 18F-Fluorodeoxyglucose positron emission tomography/computer tomography (FDG-PET/CT) has been proposed in the evaluation of VTE to detect thrombi in any anatomic location, to differentiate acute from chronic VTE, and to differentiate bland VTE from tumor thrombosis. The aim of this systematic review was to assess if the potential uses of FDG-PET/CT in VTE are described and documented in the literature and to appraise the literature. PubMed and Embase databases were searched. Duplicates and papers in other languages than English and Scandinavian were removed. Remaining papers were screened by title and abstract. Eligible papers were assessed in full text. The master search yielded 3897 hits; 316 papers were eligible for full-text assessment. Ten papers were included: six on diagnostic performance of PET/CT in VTE, and four on the ability of PET/CT to differentiate bland VTE from tumor thrombosis. Three papers were prospective; seven were retrospective. The available literature is too sparse to draw firm conclusions; however, FDG-PET/CT may have a role in diagnosing early DVT, but not PE, in discriminating acute from chronic VTE, in demonstrating recurrent VTE, and possibly for screening for occult malignancy.