Rim of FDG Uptake Around a Pulmonary Infarct on PET/CT in a Patient With Unsuspected Pulmonary Embolism

Badr, Aref; Joyce, Judith M.; Durick, Janet E.

doi:10.1097/rlu.0b013e31819e52bc

Cited by 10 publications

(10 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…FDG uptake is certainly related to this inflammatory peripheral process. A rim of FDG uptake in a pulmonary infarction was described in one patient by Badr [11]. …”

Section: Discussionmentioning

confidence: 99%

The rim sign: FDG-PET/CT pattern of pulmonary infarction

et al. 2012

View full text Add to dashboard Cite

ObjectiveWe aimed to describe a pattern of rim uptake observed in lung infarction on FDG-PET/CT, called the “rim sign.” It was defined as a continuous slight FDG uptake along the border of a subpleural consolidation without uptake within the consolidation.MethodsWe retrospectively reviewed the FDG-PET/CT studies of 400 patients referred for thoracic oncological workup from November 2010 to July 2011. The rim sign was observed in six patients who had confirmed pulmonary infarction (PI) on MDCT showing acute pulmonary embolism (n = 4) or tumoral arterial obstruction (n = 2).ResultsEight PIs in the six patients exhibited the rim sign with slight uptake (median SUVmax: 3.6, 2.2–6.8) and median size of 48.5 mm (30–74). On MDCT, central lucencies, triangular shape and vessel sign were observed in 5/8, 4/8 and 1/8 cases, respectively. Two out of the eight PIs exhibited only the rim sign and none the suggestive MDCT sign.ConclusionThe rim sign is easily recognisable at FDG-PET/CT and is strongly suggestive of PI. This pattern can be observed even in the absence of suggestive findings on MDCT. Recognition of this sign should prompt investigations for pulmonary embolism.Main Messages• The rim sign is a slight FDG uptake around an area of subpleural consolidation• The rim sign is strongly suggestive of pulmonary infarction• Recognition of the rim sign should prompt investigations for pulmonary embolism

show abstract

“…FDG uptake is certainly related to this inflammatory peripheral process. A rim of FDG uptake in a pulmonary infarction was described in one patient by Badr [11]. …”

Section: Discussionmentioning

confidence: 99%

The rim sign: FDG-PET/CT pattern of pulmonary infarction

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Multiple PET findings have been described in association with pulmonary emboli, including pulmonary artery hypermetabolism (13,(22)(23)(24), four-chamber cardiac uptake (25), and the presence of a rim of hypermetabolism surrounding a pulmonary infarction (26,27). However, the relative frequency of these findings has not been previously described.…”

Section: Discussionmentioning

confidence: 74%

The Incidence of Pulmonary Embolism and Associated FDG-PET Findings in IV Contrast-Enhanced PET/CT

et al. 2014

View full text Add to dashboard Cite

Rationale and Objectives: Most fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography with computed tomography (PET/ CT) studies are performed on cancer patients. These patients are at increased risk of pulmonary embolism (PE). In this retrospective review, we determined the rate of PE, and the prevalence of associated FDG-PET findings on intravenous (IV) contrast-enhanced PET/CT. Materials and Methods:We identified all PET/CT studies performed at our institution with a reported finding of PE between January 2005 and October 2012. The medical record was reviewed for symptoms, which were identified after the diagnosis of PE, and whether the patients received treatment. The prevalence of associated FDG-PET findings was determined.Results: A total of 65 total cases of PE (of 182,72 total PET/CT examinations) were identified of which 59 were previously unknown. This gives an incidental PE (IPE) rate of 0.32%. Of the patients where sufficient clinical information was available, 34 of 36 (94%) were treated either with therapeutic anticoagulation or inferior vena cava filter, and 30 of 36 (83%) were asymptomatic in retrospect. Of the patients with IPE, we found nine (15.2%) with associated focal pulmonary artery hypermetabolism, three (5.1%) with hypermetabolic pulmonary infarction, and one with increased isolated right ventricular FDG uptake (1.7%). One case of chronic PE demonstrated a focal hypometabolic filling defect in a pulmonary artery on PET. Conclusions:We found IPE in 0.32% of PET/CT scans. Focal pulmonary artery hypermetabolism or hypometabolism, and hypermetabolic pulmonary artery infarction with the ''rim sign'' were uncommonly associated with PE. These findings could raise the possibility of IPE in non-IV contrast-enhanced PET/CT studies.

show abstract

“…More than half of DVTs occur in calf veins or pelvic veins, where ultrasonography has limited sensitivity and none of the above mentioned techniques address vessels outside the pulmonary and proximal femoral vasculature. FDG-PET/CT provides whole-body assessment, and a mounting number of case reports demonstrate sightings of venous activity consistent with VTE in venous vasculature throughout the body and in various clinical settings: lower extremity veins [24][25][26][27][28], iliac vein [26], upper extremity veins [29][30][31], superior vena cava [32,33], inferior vena cava [34][35][36], portal vein [37,36], renal vein [34], jugular vein [38], brachiocephalic vein [33,39], indwelling catheters [40][41][42], superior sagittal sinus [43,33], pulmonary embolism (including supposed microembolism from injection artefacts) [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58], lung infarction [59][60][61], right-heart...…”

Section: Discussionmentioning

confidence: 99%

FDG-PET/CT in venous thromboembolism

Hess

Frary

Gerke

et al. 2018

Clin Transl Imaging

View full text Add to dashboard Cite

Purpose: Venous thromboembolism (VTE) is common; deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most common presentations. VTE may arise in the entire venous bed and the diagnosis may be difficult. VTE is a dynamic disease, inflammation is key, and FDG-PET/CT has been proposed, e.g. 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 18 F-Fluorodeoxyglucose positron emission tomography/computer tomography (FDG-PET/CT) in VTE are described and documented in the literature. Methods: 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. Results: The master search yielded 3,897 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. Conclusion: If applied early, FDG-PET/CT may have a role in diagnosing DVT, but not PE, to discriminate acute from chronic VTE, and to demonstrate recurrent VTE. FDG-PET/CT is by some considered adept in differentiating bland VTE from tumor thrombosis, but we find this controversial due to FDG avidity in bland VTE. FDG-PET/CT may be feasible when screening for occult malignancy. However, in all mentioned areas, available literature is too sparse and too heterogeneous to allow firm conclusions.

show abstract

Rim of FDG Uptake Around a Pulmonary Infarct on PET/CT in a Patient With Unsuspected Pulmonary Embolism

Cited by 10 publications

References 7 publications

The rim sign: FDG-PET/CT pattern of pulmonary infarction

The rim sign: FDG-PET/CT pattern of pulmonary infarction

The Incidence of Pulmonary Embolism and Associated FDG-PET Findings in IV Contrast-Enhanced PET/CT

FDG-PET/CT in venous thromboembolism

Contact Info

Product

Resources

About