Response to Letter Regarding Article, “ 18 F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Enables the Detection of Recurrent Same-Site Deep Vein Thrombosis by Illuminating Recently Formed, Neutrophil-Rich Thrombus”
Year: 2015
Type: letter
Abstract: We thank Dr Klok and colleagues for their comments on our article.1 Deep venous thrombosis (DVT) is a relatively common disorder that is associated with potentially deadly complications, such as pulmonary embolism, and carries a substantial risk for the postthrombotic syndrome and recurrent DVT.Novel strategies are needed to predict and ultimately to reduce the development of such DVTrelated complications.It is in this context that our group recently presented a novel application of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging of inflammation to detect recurrent DVT, a vexing clinical problem insufficiently addressed by duplex ultrasound. 1 In their letter, Klok et al posed questions about aspects of the clinical substudy reported in our article.We wish to provide some answers to their inquiries.One issue raised by Klok et al concerns the fact that our clinical substudy was retrospective in nature; thus, we are unable to determine from our data how quickly the DVT signal becomes positive after the appearance of a new DVT.To some degree, that answer is provided by a prospective clinical study by Rondina et al 2 in which FDG PET/CT was used to image clinical DVT, including in serial fashion.That study showed that the FDG PET signal is elevated by day 7 (information before day 7 was not reported) and can remain elevated out to 70 days after the diagnosis of DVT.Klok et al additionally asked whether dietary manipulation is mandated before imaging and whether such manipulation would limit the clinical utility of FDG PET.We wish to clarify that special dietary manipulation (besides a brief fasting period) is not required for extracardiac imaging (unlike the case with coronary atherosclerosis studies).3 We also wish to highlight that a cadre of new PET tracers (such as translocator protein) 4 are being developed for clinical imaging of inflammation and may further enhance the ability of PET/CT to detect the inflammatory process within DVT.Given the experimental and clinical data 1-3 and the widespread availability of FDG PET/CT, we believe that broader investigation is warranted to investigate the potential clinical utility of FDG PET/ CT in the management of primary and recurrent DVT.Such studies should evaluate whether FDG PET/CT imaging provides better risk stratification of patients with DVT or whether such imaging can be used to test new treatments designed to limit DVT-related complications.Furthermore, Klok et al raised awareness of a multicenter trial in patients with recurrent DVT that will evaluate the clinical utility and cost-effectiveness of magnetic resonance direct thrombus imaging, a magnetic resonance imaging method used for more than a decade to study DVT.We look forward to reviewing their findings, along with the findings of studies reporting on novel DVT-targeted imaging approaches, especially those that may provide additional molecular specificity.5
Source: Circulation
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1620982870