Abstract
Purpose
The aim of this study was the evaluation of quantitative and qualitative parameters for the diagnosis of aortic graft infection (AGI) using [18F]-FDG PET/CT.
Methods
PET/CT was performed in 50 patients with clinically suspected AGI. 12 oncological patients with aortic repair but without suspicion of AGI were included in the analysis to serve as control cohort. The [18F]-FDG uptake pattern around the graft was assessed using (a) a five-point visual grading scale (VGS), (b) SUVmax and (c) different graft-to-background ratios (GBRs). The diagnostic performance of VGS, SUVmax and GBRs was assessed and compared by ROC analysis.
Results
28 infected and 34 uninfected grafts were identified by standard of reference. SUVmax and VGS were the most powerful predictors for the diagnosis of AGI according to the area under the curve (AUC 0.988 and 0.983, respectively) without a significant difference compared to GBRs. SUVmax and VGS showed congruent and accurate findings in 54 patients (i.e. either both positive or negative), yielding sensitivity and specificity (100%) in this subgroup of patients.
Conclusion
Quantitative analysis by SUVmax and qualitative analysis by VGS are highly effective in the diagnosis of AGI and should be tested as an outcome measure in prospective trials.
Similar content being viewed by others
Abbreviations
- AGI:
-
Aortic graft infection
- AUC:
-
Area under the curve
- CI:
-
Confidence interval
- CT:
-
Computed tomography
- [18F]-FDG:
-
[18F]-Fluorodeoxyglucose
- GBR:
-
Graft-to-background ratio
- PET:
-
Positron emission tomography
- ROC:
-
Receiver-operating-characteristic
- SUV:
-
Standardized uptake value
- VGS:
-
Visual grading scale
References
Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, et al. Vascular graft infections, mycotic aneurysms, and endovascular infections: A scientific statement from the American Heart Association. Circulation 2016;134:e412-60.
Lyons OT, Baguneid M, Barwick TD, Bell RE, Foster N, Homer-Vanniasinkam S, et al. Diagnosis of aortic graft infection: A case definition by the Management of Aortic Graft Infection Collaboration (MAGIC). Eur J Vasc Endovasc Surg 2016;52:758-63.
Reinders Folmer EI, Von Meijenfeldt GCI, Van der Laan MJ, Glaudemans A, Slart R, Saleem BR, et al. Diagnostic imaging in vascular graft infection: A systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2018;56(5):719-29.
Treglia G. Diagnostic performance of (18)F-FDG PET/CT in infectious and inflammatory diseases according to published meta-analyses. Contrast Media Mol Imaging 2019;2019:3018349.
Rojoa D, Kontopodis N, Antoniou SA, Ioannou CV, Antoniou GA. 18F-FDG PET in the diagnosis of vascular prosthetic graft infection: A diagnostic test accuracy meta-analysis. Eur J Vasc Endovasc Surg 2019;57:292-301.
Blomberg BA, Bashyam A, Ramachandran A, Gholami S, Houshmand S, Salavati A, et al. Quantifying [(1)(8)F]fluorodeoxyglucose uptake in the arterial wall: The effects of dual time-point imaging and partial volume effect correction. Eur J Nucl Med Mol Imaging 2015;42:1414-22.
van den Hoff J, Lougovski A, Schramm G, Maus J, Oehme L, Petr J, et al. Correction of scan time dependence of standard uptake values in oncological PET. EJNMMI Res 2014;4:18.
Bruggink JL, Glaudemans AW, Saleem BR, Meerwaldt R, Alkefaji H, Prins TR, et al. Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endovasc Surg 2010;40:348-54.
Saleem BR, Berger P, Vaartjes I, de Keizer B, Vonken EJ, Slart RH, et al. Modest utility of quantitative measures in (18)F-fluorodeoxyglucose positron emission tomography scanning for the diagnosis of aortic prosthetic graft infection. J Vasc Surg 2015;61:965-71.
Berger P, Vaartjes I, Scholtens A, Moll FL, De Borst GJ, De Keizer B, et al. Differential FDG-PET uptake patterns in uninfected and infected central prosthetic vascular grafts. Eur J Vasc Endovasc Surg 2015;50:376-83.
Sah BR, Husmann L, Mayer D, Scherrer A, Rancic Z, Puippe G, et al. Diagnostic performance of 18F-FDG-PET/CT in vascular graft infections. Eur J Vasc Endovasc Surg 2015;49:455-64.
Husmann L, Huellner MW, Ledergerber B, Anagnostopoulos A, Stolzmann P, Sah BR, et al. Comparing diagnostic accuracy of (18)F-FDG-PET/CT, contrast enhanced CT and combined imaging in patients with suspected vascular graft infections. Eur J Nucl Med Mol Imaging 2018;46(6):1359-68.
Kim SJ, Lee SW, Jeong SY, Pak K, Kim K. A systematic review and meta-analysis of (18)F-fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography for detection of infected prosthetic vascular grafts. J Vasc Surg 2019;70:307-13.
Fukuchi K, Ishida Y, Higashi M, Tsunekawa T, Ogino H, Minatoya K, et al. Detection of aortic graft infection by fluorodeoxyglucose positron emission tomography: Comparison with computed tomographic findings. J Vasc Surg 2005;42:919-25.
Tokuda Y, Oshima H, Araki Y, Narita Y, Mutsuga M, Kato K, et al. Detection of thoracic aortic prosthetic graft infection with 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Eur J Cardiothorac Surg 2013;43:1183-7.
Saleem BR, Beukinga RJ, Boellaard R, Glaudemans AW, Reijnen MM, Zeebregts CJ, et al. Textural features of (18)F-fluorodeoxyglucose positron emission tomography scanning in diagnosing aortic prosthetic graft infection. Eur J Nucl Med Mol Imaging 2017;44:886-94.
Rudd JH, Myers KS, Bansilal S, Machac J, Pinto CA, Tong C, et al. Atherosclerosis inflammation imaging with 18F-FDG PET: Carotid, iliac, and femoral uptake reproducibility, quantification methods, and recommendations. J Nucl Med 2008;49:871-8.
Verloh N, Einspieler I, Utpatel K, Menhart K, Brunner S, Hofheinz F, et al. In vivo confirmation of altered hepatic glucose metabolism in patients with liver fibrosis/cirrhosis by (18)F-FDG PET/CT. EJNMMI Res 2018;8:98.
Sorensen M, Mikkelsen KS, Frisch K, Bass L, Bibby BM, Keiding S. Hepatic galactose metabolism quantified in humans using 2-18F-fluoro-2-deoxy-d-galactose PET/CT. J Nucl Med 2011;52:1566-72.
Szopa IGK, d’Amico A, Jarząb B. Is there a necessity of Standard Uptake Value correction in liver reference level? In: Dössel O, Schlegel WC, editors. World Congress on Medical Physics and Biomedical Engineering, September 7-12, 2009, Munich, Germany. Berlin: Springer; 2009. p. 627-9.
Husmann L, Ledergerber B, Anagnostopoulos A, Stolzmann P, Sah BR, Burger IA, et al. The role of FDG PET/CT in therapy control of aortic graft infection. Eur J Nucl Med Mol Imaging 2018;45:1987-97.
Kagna O, Kurash M, Ghanem-Zoubi N, Keidar Z, Israel O. Does antibiotic treatment affect the diagnostic accuracy of (18)F-FDG PET/CT studies in patients with suspected infectious processes? J Nucl Med 2017;58:1827-30.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
All authors have nothing to declare. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.
The authors have also provided an audio summary of the article, which is available to download as ESM, or to listen to via the JNC/ASNC Podcast.
Funding
The authors state that this work has not received any funding.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Einspieler, I., Mergen, V., Wendorff, H. et al. Diagnostic performance of quantitative and qualitative parameters for the diagnosis of aortic graft infection using [18F]-FDG PET/CT. J. Nucl. Cardiol. 28, 2220–2228 (2021). https://doi.org/10.1007/s12350-019-02011-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12350-019-02011-4