Clinical Research
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 28, 2008; 14(8): 1212-1217
Published online Feb 28, 2008. doi: 10.3748/wjg.14.1212
Highly metabolic thrombus of the portal vein: 18F fluorodeoxyglucose positron emission tomography/computer tomography demonstration and clinical significance in hepatocellular carcinoma
Long Sun, Yong-Song Guan, Wei-Ming Pan, Gui-Bing Chen, Zuo-Ming Luo, Ji-Hong Wei, Hua Wu
Long Sun, Wei-Ming Pan, Gui-Bing Chen, Zuo-Ming Luo, Ji-Hong Wei, Hua Wu, Minnan PET Center, The First Hospital of Xiamen, Fujian Medical University, Xiamen 316003, Fujian Province, China
Yong-Song Guan, West China Hospital of Sichuan University, Chengdu, China, 610041; State Key Laboratory of Biotherapy, West China Medical School, Sichuan University, Gaopeng Street, Keyuan Road 4, Chengdu 610041, Sichuan Province, China
Author contributions: Sun L wrote the paper and organized the figures and patient data; Pan WM, Chen GB, Luo ZM and Wei JH completed patient follow-ups and data collection; Guan YS helped to write, organize, and correct the paper; Wu H supervised the writing and organization process.
Correspondence to: Hua Wu, Minnan PET Center, The First Hospital of Xiamen, Fujian Medical University, Xiamen 316003, Fujian Province, China. wuhua1025@163.com
Telephone: +86-592-2139527
Fax: +86-592-2139527
Received: November 7, 2007
Revised: December 19, 2007
Published online: February 28, 2008
Abstract

AIM: To assess the ability of 18F-fluorodeoxyglucose positron emission tomography/computer tomography (18F-FDG PET/CT) to differentiate between benign and malignant portal vein thrombosis in hepatocellular carcinoma (HCC) patients.

METHODS: Five consecutive patients who had HBV cirrhosis, biopsy-proven HCC, and thrombosis of the main portal vein and/or left/right portal vein on ultrasound (US), computer tomography (CT) or magnetic resonance imaging (MRI) were studied with 18F-FDG PET/CT. The presence or absence of a highly metabolic thrombus on 18F-FDG PET/CT was considered diagnostic for malignant or benign portal vein thrombosis, respectively. All patients were followed-up monthly with US, CT or MRI. Shrinkage of the thrombus or recanalization of the vessels on US, CT or MRI during follow-up was considered to be definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered to be consistent with malignancy. 18F-FDG PET/CT, and US, CT or MRI results were compared.

RESULTS: Follow-up (1 to 10 mo) showed signs of malignant thrombosis in 4 of the 5 patients. US, CT or MRI produced a true-positive result for malignancy in 4 of the patients, and a false-positive result in 1. 18F-FDG PET/CT showed a highly metabolic thrombus in 4 of the 5 patients. 18F-FDG PET/CT achieved a true-positive result in all 4 of these patients, and a true-negative result in the other patient. No false-positive result was observed using 18F-FDG PET/CT.

CONCLUSION: 18F-FDG PET/CT may be helpful in discriminating between benign and malignant portal vein thrombi. Patients may benefit from 18F-FDG PET/CT when portal vein thrombi can not be diagnosed exactly by US, CT or MRI.

Keywords: 18F-fluorodeoxyglucose; Positron emission tomography/computer tomography; Hepatocellular carcinoma; Portal vein tumor thrombus; Portal vein blood thrombus