Aging of acute deep vein thrombosis measured by radiolabeled 99mTc-rt-PA.
In previous studies, (99m)Tc-recombinant tissue plasminogen activator (rt-PA) imaging has had a high sensitivity and specificity for the detection of deep vein thrombosis (DVT). In this technique, the plasminogen activation site of rt-PA undergoes inactivation but fibrin binding is retained. Uptake of (99m)Tc-rt-PA into DVT relies on binding of C-terminal lysine residues on fibrin. It is postulated that as the thrombus ages, fewer fibrin sites are available for (99m)Tc-rt-PA and that there should be a progressive decrease in (99m)Tc-rt-PA uptake in old thrombi as compared with fresh thrombi. The ability to differentiate fresh from old thrombus would have significant clinical implications in the objective diagnosis of recurrent DVT. Our aim was to examine the relative uptake of (99m)Tc-rt-PA in acute DVT over the first 30 d after diagnosis.


METHODS
Seventy-four patients with acute symptomatic DVT were entered into the study. Patients underwent ultrasound and (99m)Tc-rt-PA imaging on days 1, 7, and 30.


RESULTS
Residual thrombus was detected by ultrasonography in 46 (84%) of 55 patients on day 7 and in 29 (66%) of 44 patients on day 30. Of the persisting thrombi on day 7, 72% (33/46) showed (99m)Tc-rt-PA uptake. Of the persisting thrombi on day 30, 0% (0/29) showed (99m)Tc-rt-PA uptake.


CONCLUSIONS
Uptake of (99m)Tc-rt-PA into DVT was absent 30 d after diagnosis. This finding suggests that this imaging technique can distinguish fresh from old thrombus.
Brighton
Timothy
T
Department of Haematology, St. George Hospital, Sydney, New South Wales, Australia.
Janssen
Julia
J
Butler
S Patrick
SP
D000208:Acute Disease; D005260:Female; D005337:Fibrin / Q000378:metabolism; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009088:Mucoproteins / Q000378:metabolism; D010960:Plasminogen Activators / Q000378:metabolism*; D011485:Protein Binding; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000378:metabolism*; D011994:Recombinant Proteins / Q000378:metabolism; D012008:Recurrence; D013667:Technetium; D013848:Thigh / Q000098:blood supply; D013997:Time Factors; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging / Q000378:metabolism; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000473:pathology
D009088:Mucoproteins; D019275:Radiopharmaceuticals; D011994:Recombinant Proteins; C010393:lysin, gastropoda; D013667:Technetium; D005337:Fibrin; D010960:Plasminogen Activators