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Shannon M. Bates, MD, CM; John Lister-James, PhD; Jim A. Julian, MMath; Raymond Taillefer, MD; Brian R. Moyer, BSc, MSc; Jeffrey S. Ginsberg, MD

Arch Intern Med. 2003;163:452-456.

Background  The diagnosis of recurrent deep vein thrombosis (DVT) is challenging. Imaging with radiolabeled peptides offers a new approach for detecting acute DVT. Technetium Tc 99m (^99mTc)–apcitide binds with high affinity and specificity to the glycoprotein IIb/IIIa receptors expressed on activated platelets and, therefore, ^99mTc-apcitide scintigraphy should be negative with residual abnormalities caused by old, inactive thrombi and positive with new, active thrombi.

Methods  In a prospective multicenter study, ^99mTc-apcitide imaging was performed on 38 patients with a newly diagnosed first DVT (group 1) and 40 patients with previous DVT, symptoms of postthrombotic syndrome, and chronic intraluminal abnormalities on ultrasonography (group 2). Images were interpreted in a blinded fashion by 2 experts and by newly trained nuclear medicine physicians. The sensitivity and specificity of ^99mTc-apcitide were determined by calculating the proportion of scans in group 1 patients that were read as "positive for acute DVT" and the proportion of scans in group 2 patients that were read as "negative for acute DVT," respectively.

Results  When read by 2 experts, ^99mTc-apcitide had a sensitivity of 92% for both readers and specificities of 82% and 90%. Agreement between the experts was excellent. However, the accuracy and interreader agreement for newly trained nuclear medicine physicians were lower.

Conclusions  Technetium Tc 99m–apcitide scintigraphy has potential utility in suspected recurrent DVT because it detects most acute thrombi and has few false-positive results in patients with previous DVT. However, the accuracy appears to depend on the training and experience of the interpreters.

From the Departments of Medicine (Drs Bates and Ginsberg) and Clinical Epidemiology and Biostatistics (Mr Julian), McMaster University, Hamilton, Ontario; Berlex Laboratories, Inc, Montville, NJ (Dr Lister-James and Mr Moyer); and Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Pavillon Hôtel-Dieu, Montreal, Quebec (Dr Taillefer). Drs Bates and Ginsberg have signed consulting agreements with Berlex Laboratories, Inc (which has acquired Diatide, Inc, Londonderry, NH).

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