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How to recognize stent graft infection after endovascular aortic repair: the utility of 18F-FDG PET/CT in an infrequent but serious clinical setting

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Abstract

Objective

To evaluate the diagnostic performance of 18F-FDG PET/CT in the detection of stent graft infection (SGI).

Methods

In a retrospective study, two nuclear medicine physicians have independently analyzed 17 18F-FDG PET/CT examinations performed for clinical suspicion of SGI. The images were evaluated for the uptake pattern and intensity, and by the maximum standard uptake value (SUVmax), the target-to-background ratio with blood pool (TBRBP) and liver uptake (TBRhep) as a reference. The SGI was defined as the presence of focal hyperactivity with an intensity exceeding hepatic uptake. CT images were independently assessed for signs of SGI. Clinical review of all further patients’ data served as the standard of reference.

Results

Nine cases were established as SGI by the clinical review. PET/CT correctly diagnosed SGI in eight and yielded a sensitivity of 89% and specificity of 100%. The mean SUVmax, TBRBP, and TBRhep values were 9.8 ± 4.0, 6.9 ± 2.6, and 4.6 ± 1.7 in the group of patients with true SGI, and 4.0 ± 1.1, 2.5 ± 0.4 (p < 0.001) and 1.9 ± 0.2 (p < 0.001) in true negative cases, respectively. CT alone showed a sensitivity of 78% and specificity of 100% and was concordant with PET/CT in 14 cases. The best performing threshold values of SUVmax, TBRBP, and TBRhep were 5.6, 3.5, and 2.2, respectively.

Conclusion

18F-FDG PET/CT with expert evaluation, semiquantitative and quantitative image analysis with the proposed threshold values for SUVmax, TBRBP, and TBRhep has good diagnostic accuracy in the detection of SGI. We propose that visual grading scale for SGI should use hepatic uptake as a visual reference.

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Acknowledgements

This study was supported by the First Faculty of Medicine, Charles University under Progres Q28/LF1 and UNCE 204065.

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Authors and Affiliations

  1. Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic

    David Zogala, Vaclav Ptacnik & Jiri Trnka

  2. The National Institute of Cardiovascular Diseases, Bratislava, Slovakia

    David Rucka & Petr Varejka

  3. Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic

    Vladimir Cerny & Lukas Lambert

  4. 2nd Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic

    Samuel Heller

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  1. David Zogala
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  2. David Rucka
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  3. Vaclav Ptacnik
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  4. Vladimir Cerny
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  8. Lukas Lambert
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Correspondence to Lukas Lambert.

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Zogala, D., Rucka, D., Ptacnik, V. et al. How to recognize stent graft infection after endovascular aortic repair: the utility of 18F-FDG PET/CT in an infrequent but serious clinical setting. Ann Nucl Med 33, 594–605 (2019). https://doi.org/10.1007/s12149-019-01370-9

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  • DOI: https://doi.org/10.1007/s12149-019-01370-9

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