Abstract
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Introduction: Tumour thrombus formation is one of the most common complication in oncological patients due to hypercoagulable state. Timely diagnosis and treatment plays an important role in reducing morbidity and mortality in cancer patients. The present study was aimed to look for the thrombotic patterns in different tumors in 18F-FDG PET/CT imaging.
Methods: We retrospectively reviewed all 18F-FDG PET/CT scans of patients done in Nuclear Medicine department of AIIMS, New Delhi from January 2017 to December 2021. All scans were reviewed by two experienced nuclear medicine physicians. A total of 87 patients who had tumor thrombus in 18F-FDG PET/CT scans were included. All the 18F-FDG PET/CT scans of 87 patients were analyzed for primary tumor site and site of thrombus. The SUV max of primary tumor, thrombus and background (aorta) were calculated.
Results: A total of 87 patients were included with an age range of 43 to 60 years (Mean 53 ± 14.10 years). There were 62 males and 25 females. Of 87 patients, most common malignancies were hepatocellular cancer ( 29/87;33.33%), renal cell cancer (25/87; 28.73%) and carcinoma of thyroid (6/87; 6.89%). Of 87 patients, (34/87; 39.08%) had tumor thrombosis in inferior vena cava, (20/87; 22.98%) in portal vein and (33/87; 37.93%) in other vessels (renal vein, jugular vein etc.). FDG uptake was linear with dilatation of affected veins in 80 patients and focal in the rest of 7 patients. The mean SUV max of the primary tumors was 10.03 (range, 2.1-36.0; median, 8.46), thrombi was 8.41 (range, 1.54-33.5; median, 6.74) and background was 2.86 (range, 0.78-10.2; median 2.27). There was a significant difference between the SUV max of the primary when compared to the background SUV max with p value of 0.036 (< 0.05).
Conclusions: 18F-FDG PET/CT plays an important role in the detection of tumor thrombosis and the most common thrombotic pattern in different tumors was linear FDG uptake.