The Diagnostic Value of FDG PET/CT and Thin-Slice High-Resolution Chest CT in Pulmonary Intravascular Metastasis

OBJECTIVE. Pulmonary intravascular metastasis is a special type of pulmonary metastasis of malignancies; however, few relevant studies have been performed. This study aimed to determine the characteristics of pulmonary intravascular metastasis and improve understanding of the disease by retrospective analysis of FDG PET/CT and thin-layer high-resolution CT (HRCT) imaging of the chest in patients with tumors. MATERIALS AND METHODS. We identified all patients who underwent FDG PET/CT at two hospitals between January 2016 and February 2019 and conducted a comparative analysis of HRCT and PET/CT images. In total, 84 patients (38 women and 46 men) ranging in age from 35 to 82 years old (mean age, 54.7 ± 14.5 [SD] years) participated in the study. Patient characteristics were summarized, and diagnosis was confirmed by chest CT or PET/CT follow-up. RESULTS. A total of 260 pulmonary intravascular metastases were found, which were classified as type I (no significant abnormality, n = 5), type II (abrupt and uneven thickening of the pulmonary vessel, n = 118), type III (simultaneous invasion of adjacent pulmonary vessel, n = 121), and type IV (large strip-shaped high-density mass, n = 16). The majority were located in peripheral pulmonary vessels (94.2% [245/260]). FDG up-take was increased in 252 lesions, and the mean SUVmax was 4.6 ± 2.5. CONCLUSION. The combination of PET/CT and chest HRCT is an effective approach for detecting pulmonary intravascular metastasis. The linear pattern of FDG uptake, abnormal pulmonary blood vessel morphology, and location (below the lung segment) are specific indicators for the diagnosis of pulmonary intravascular metastasis and should be recognized by clinicians and radiologists.