Tariq Mahmood Mirza, Amin Waqar, Mujahid Khalid Ali, Fida Hussain, Karamat Ahmed Karamat.
Evaluation of acute DVT by using Tc-99m Apcitide (AcuTect).
Pak J Pathol Jan ;9(4):33-4.

The diagnosis of deep vein thrombosis (DVT) in acute phase can produce dramatic results in the prevention of thrombotic complications and its treatment. So it was long desired to diagnose DVT in acute phase by a painless and noninvasive procedure. Apcitide (AcuTect) [1] is claimed to be the first imaging modality to target acute DVT. The detection of acute DVT is a great problem even with ultrasound and contrast venography particularly in calf veins.The fresh clots may not be detected by ultrasound due to lack of echogenecity and in contrast venography, which is an invasive and painful procedure, visualization is limited, particularly in areas of dilution.

A 66 year old man was admitted in Military Hospital Rawalpindi on 20th September 99, with the complaint of an event of unconsciousness for a short duration and he was unable to speak properly for the last 04 hours. He was a known diabetic and hypertensive with the history of CVA 04 years back which had affected his right side of body. The recovery from the effects of CVA are partial uptill now. There was also a history of injury to the left hip joint about 06 months back. No other physical abnormality was detected at the time of admission. Next day, on 21st September 99, he started developing swelling on his left lower leg which was increasing in severity with passage of time. The patient was afebrile but the lower left limb was slightly tender to touch. The provisional diagnosis of acute DVT was made and the patient was referred for radioisotope venogram. His coagulation profile, liver enzymes and D-dimers were within normal range.Patient`s venogram was done by using Scintronix gamma camera. The Technetium- 99m was used as a radioactive agent and the energy window was set at 140 Kev with photopeak at 20%. 128128 matrix was selected for image acquisition.The injection was prepared by labelling Apcitide (AcuTect) with Tc-99m according to the specified procedure [4]. Then Tc-99m Apcitide (AcuTect) was injected into the peripheral vein of right arm. The images were acquired at 10, 60 and 120 minutes post injection. Both anterior and posterior views were taken for 800 K counts. The order for anterior views was pelvis including upper thighs/ knees, mid-thigh to mid calf/ calves, just above the knees to just above the ankles. The posterior views were also acquired in the same order.

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