Key result
Non-contrast 18F-FDG PET/CT detects ancillary signs of pulmonary embolism confirmed on CTPA.
Why the study?
The diagnosis of pulmonary embolism on 18F‐FDG PET/CT is challenging, particularly without intravenous contrast, in oncology patients at high risk of PE.
Case Report (n=1)
Non-contrast 18F-FDG PET/CT can reveal ancillary signs of pulmonary embolism, such as the rim sign and right heart strain, in oncology patients.
May flag incidental PE on non-contrast PET/CT in oncology; case report leaves open diagnostic role and validation needs.
18F‐labelled fluoro‐2‐deoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT) is used extensively in the setting of cancer staging and in assessing cancer treatment response. Oncology patients have a sevenfold risk of developing pulmonary embolism (PE) due to underlying activation of the haemostatic system and anti‐cancer therapy inducing a hypercoagulable state. The diagnosis of PE on 18F‐FDG PET/CT is challenging, particularly in the absence of intravenous contrast. The case of a female patient undergoing treatment for advanced diffuse large B‐cell lymphoma is presented. The ancillary signs of PE are illustrated on consecutive non‐contrast‐enhanced 18F‐FDG PET/CT scans. The signs include the “rim sign” relating to regions of pulmonary infarction and abnormal cardiac uptake indicating right heart strain. The diagnosis was confirmed on CT pulmonary angiography which demonstrated extensive PE, including a saddle embolus.
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Singh et al. (2019) conducted a case report in Pulmonary embolism in advanced diffuse large B-cell lymphoma (n=1). 18F-FDG PET/CT was evaluated on Diagnosis of pulmonary embolism. Non-contrast-enhanced 18F-FDG PET/CT identified ancillary signs of pulmonary embolism, including the 'rim sign' and abnormal cardiac uptake, which was confirmed as a saddle embolus on CTPA.
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