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Diagnosis of Deep Septic Thrombophlebitis in Cancer Patients by Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography Scanning: A Preliminary Report

From the University of Arkansas for Medical Sciences, Myeloma Institute for Research and Therapy and Department of Radiology, Little Rock, AR; Department of Breast Surgical Oncology, The M.D. Anderson Cancer Center, Houston, TX; Department of Infectious Diseases, Lebanese University, Beirut, Lebanon; and Department of Vascular Surgery, Hospital Profesor Alejandro Posadas, Buenos Aires, Argentina.

Address reprint requests to Elias J. Anaissie, MD, Supportive Care, Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, 4301 W Markham, #776, Little Rock, AR 72205; e-mail: anaissieeliasj{at}uams.edu

PURPOSE: To determine the role of the fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scan in the diagnosis and management of deep septic thrombophlebitis (STP).

PATIENTS AND METHODS: We conducted a prospective observational evaluation of FDG-PET in patients with cancer and suspected STP. Retrospective evaluation of patients with cancer and deep venous thrombosis (DVT) who underwent FDG-PET and extremity duplex scan (DS) was also performed.

RESULTS: Strong venous uptake was observed in FDG-PET of nine STP episodes versus 0 of 27 DVT episodes (P < .001). FDG-PET identified central vein STP in five patients, whereas DS and venography were negative in five and two of these patients, respectively. FDG-PET diagnosis of STP resulted in therapeutic changes in all patients. In four patients, follow-up FDG-PET confirmed resolution.

CONCLUSION: In cancer patients, FDG-PET identifies STP even in areas not optimally visualized by DS or venography, distinguishes STP from DVT, and leads to significant therapeutic changes.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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