Clinical and Translational Imaging

, Volume 7, Issue 4, pp 255–265 | Cite as

FDG-PET/CT as a diagnostic tool in vascular graft infection: a systematic review and meta-analysis

  • Synnøve Klyve Sunde
  • Therese Beske
  • Oke Gerke
  • Lene Langhoff Clausen
  • Søren HessEmail author
Part of the following topical collections:
  1. Infection and inflammation



Vascular graft infection (VGI) in central grafts is a rare but dreaded complication with a high mortality. Several imaging modalities are employed, all with pros and cons. Computed tomography is the standard, but lacks sensitivity for low-grade infections. There is still no consensus regarding the diagnostic modality of choice. The study objective was to assess the role of combined positron emission tomography and computed tomography with fluorodeoxyglucose (FDG-PET/CT) in the diagnostic workup of VGI in central grafts.


A systematic review was conducted according to the PRISMA guidelines through a search in Embase, PubMed, and Cochrane databases. Meta-analysis on accuracy measures was carried out with random effects models for three parameters: focal uptake, visual grading scale (VGS), and maximum standardized uptake value (SUVmax). Heterogeneity among studies was assessed with the I-squared test.


A total of 307 studies were identified and 9 were eligible for inclusion. The pooled estimates for sensitivity and specificity for focal uptake were 90.6% (95% CI 81.7–99.4%) and 82.8% (95% CI 71.3–94.3%), respectively, for VGS 86.8% (95% CI 59.3–100%) and 69.4% (95% CI 39.9–98.9%), respectively, for SUVmax 92.8% (95% CI 83.2–100%) and 69.7% (95% CI 52.4–86.9%), respectively. A single study employed tissue-to-background ratio (TBR) and found sensitivity and specificity of 71.8% (95% CI 54.6–84.4%) and 70.4% (95% CI 51.5–84.2%), respectively.


According to this systematic review and meta-analysis, FDG-PET/CT performs well especially when using focal versus diffuse FDG uptake to diagnose VGI.


Vascular graft Infections Positron emission tomography PET Computed tomography CT 



The authors would like to thank specialist research librarian Herdis Foverskov (University Library of Southern Denmark) for the help with developing the search strategy.

Author contributions

SKS: literature search, literature review, meta-analysis, writing, editing, content planning; TB: literature search, literature review, meta-analysis, writing, editing, content planning; OG: literature review, meta-analysis, writing, editing, content planning; LLC: literature review, writing, editing, content planning; SH: literature review writing, editing, content planning.


There are no financial disclosures; this work received no funding.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

40336_2019_336_MOESM1_ESM.pdf (154 kb)
Supplementary material 1 PRISMA checklist. Adapted from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. (PDF 154 kb)
40336_2019_336_MOESM2_ESM.pdf (969 kb)
Supplementary material 2 Funnel plots (PDF 968 kb)
40336_2019_336_MOESM3_ESM.tif (1.8 mb)
Supplementary material 3 SROC-curve for focal uptake (TIFF 1886 kb)
40336_2019_336_MOESM4_ESM.docx (17 kb)
Supplementary material 4 (DOCX 17 kb)
40336_2019_336_MOESM5_ESM.docx (14 kb)
Supplementary material 5 (DOCX 13 kb)


  1. 1.
    Rojoa D, Kontopodis N, Antoniou SA, Ioannou CV, Antoniou GA (2018) 18F-FDG PET in the diagnosis of vascular prosthetic graft infection: a diagnostic test accuracy meta-analysis. Eur J Vasc Endovasc Surg 57:292–301CrossRefPubMedGoogle Scholar
  2. 2.
    Reinders Folmer EI, Von Meijenfeldt GCI, Van der Laan MJ, Glaudemans A, Slart R, Saleem BR, Zeebregts CJ (2018) Diagnostic imaging in vascular graft infection: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg 56:719–729CrossRefPubMedGoogle Scholar
  3. 3.
    Chang CY, Chang CP, Shih CC, Yang BH, Cheng CY, Chang CW, Chu LS, Wang SJ, Liu RS (2015) Added value of dual-time-point 18F-FDG PET/CT with delayed imaging for detecting aortic graft infection: an observational study. Medicine 94(27):e1124CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Karaca S, Rager O, Ratib O, Kalangos A (2018) Long-term results confirmed that 18F-FDG-PET/CT was an excellent diagnostic modality for early detection of vascular grafts infection. Q J Nucl Med 62(2):200–208Google Scholar
  5. 5.
    Orton DF, LeVeen RF, Saigh JA, Culp WC, Fidler JL, Lynch TJ, Goertzen TC, McCowan TC (2000) Aortic prosthetic graft infections: radiologic manifestations and implications for management. Radiographics 20(4):977–993. CrossRefPubMedGoogle Scholar
  6. 6.
    Basu S, Hess S, Braad P-EN, Olsen BB, Inglev S, Høilund-Carlsen PF (2014) The basic principles of FDG-PET/CT imaging. PET Clin 9(4):355–370CrossRefPubMedGoogle Scholar
  7. 7.
    Hess S, Blomberg BA, Zhu HJ, Høilund-Carlsen PF, Alavi A (2014) The pivotal role of FDG-PET/CT in modern medicine. Acad Radiol 21(2):232–249CrossRefPubMedGoogle Scholar
  8. 8.
    Zhuang H, Codreanu I (2015) Growing applications of FDG PET-CT imaging in non-oncologic conditions. J Biomed Res 29(3):189–202PubMedPubMedCentralGoogle Scholar
  9. 9.
    Vaidyanathan S, Patel CN, Scarsbrook AF, Chowdhury FU (2015) FDG PET/CT in infection and inflammation—current and emerging clinical applications. Clin Radiol 70(7):787–800CrossRefPubMedGoogle Scholar
  10. 10.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Harris R, Bradburn M, Deeks J, Harbord R, Altman D, Sterne J (2008) Metan: fixed-and random-effects meta-analysis. Stat J 8(1):3CrossRefGoogle Scholar
  12. 12.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54(10):1046–1055CrossRefGoogle Scholar
  14. 14.
    Sterne JA, Egger M, Smith GD (2001) Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ 323(7304):101CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Sterne JA, Harbord RM (2004) Funnel plots in meta-analysis. Stat J 4:127–141CrossRefGoogle Scholar
  16. 16.
    Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Chu H, Cole SR (2006) Bivariate meta-analysis of sensitivity and specificity with sparse data: a generalized linear mixed model approach. J Clin Epidemiol 59(12):1331–1332. (author reply 1332–1333) CrossRefPubMedGoogle Scholar
  18. 18.
    Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58(10):982–990. CrossRefPubMedGoogle Scholar
  19. 19.
    Bruggink JL, Glaudemans AW, Saleem BR, Meerwaldt R, Alkefaji H, Prins TR, Slart RH, Zeebregts CJ (2010) Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endovasc Surg 40(3):348–354CrossRefPubMedGoogle Scholar
  20. 20.
    Keidar Z, Engel A, Hoffman A, Israel O, Nitecki S (2007) Prosthetic vascular graft infection: the role of 18F-FDG PET/CT. J Nucl Med 48(8):1230–1236CrossRefPubMedGoogle Scholar
  21. 21.
    Spacek M, Belohlavek O, Votrubova J, Sebesta P, Stadler P (2009) Diagnostics of “non-acute” vascular prosthesis infection using 18F-FDG PET/CT: our experience with 96 prostheses. Eur J Nucl Med Mol Imaging 36(5):850–858CrossRefPubMedGoogle Scholar
  22. 22.
    Sah BR, Husmann L, Mayer D, Scherrer A, Rancic Z, Puippe G, Weber R, Hasse B, Cohort V (2015) Diagnostic performance of 18F-FDG-PET/CT in vascular graft infections. Eur J Vasc Endovasc Surg 49(4):455–464CrossRefPubMedGoogle Scholar
  23. 23.
    Bowles H, Ambrosioni J, Mestres G, Hernandez-Meneses M, Sanchez N, Llopis J, Yugueros X, Almela M, Moreno A, Riambau V, Fuster D, Miro JM, Hospital Clinic Endocarditis Study G (2018) Diagnostic yield of < sup > 18 </sup > F-FDG PET/CT in suspected diagnosis of vascular graft infection: a prospective cohort study. J Nucl Cardiol 15:15Google Scholar
  24. 24.
    Tokuda Y, Oshima H, Araki Y, Narita Y, Mutsuga M, Kato K, Usui A (2013) Detection of thoracic aortic prosthetic graft infection with 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Eur J Cardiothorac Surg 43(6):1183–1187CrossRefPubMedGoogle Scholar
  25. 25.
    Tsang JS, Chan YC, Law Y, Cheng SW (2018) Clinical experience of positron-emission tomography in infective aortic disease. Asian Cardiovasc Thorac Ann 26(1):11–18CrossRefPubMedGoogle Scholar
  26. 26.
    Berger P, Vaartjes I, Scholtens A, Moll FL, De Borst GJ, De Keizer B, Bots ML, Blankensteijn JD (2015) Differential FDG-PET uptake patterns in uninfected and infected central prosthetic vascular grafts. Eur J Vasc Endovasc Surg 50(3):376–383CrossRefPubMedGoogle Scholar
  27. 27.
    Saleem BR, Berger P, Vaartjes I, de Keizer B, Vonken EJ, Slart RH, de Borst GJ, Zeebregts CJ (2015) Modest utility of quantitative measures in (18)F-fluorodeoxyglucose positron emission tomography scanning for the diagnosis of aortic prosthetic graft infection. J Vasc Surg 61(4):965–971CrossRefPubMedGoogle Scholar
  28. 28.
    Bruggink JL, Slart RH, Pol JA, Reijnen MM, Zeebregts CJ (2011) Current role of imaging in diagnosing aortic graft infections. Semin Vasc Surg 24(4):182–190CrossRefPubMedGoogle Scholar
  29. 29.
    Houshmand S, Salavati A, Hess S, Werner TJ, Alavi A, Zaidi H (2015) An update on novel quantitative techniques in the context of evolving whole-body PET imaging. PET Clin 10(1):45–58CrossRefPubMedGoogle Scholar
  30. 30.
    Aide N, Lasnon C, Veit-Haibach P, Sera T, Sattler B, Boellaard R (2017) EANM/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies. Eur J Nucl Med Mol Imaging 44(1):17–31CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Jamar F, Buscombe J, Chiti A, Christian PE, Delbeke D, Donohoe KJ, Israel O, Martin-Comin J, Signore A (2013) EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med 54(4):647–658CrossRefPubMedGoogle Scholar
  32. 32.
    Pfaehler E, Beukinga RJ, de Jong JR, Slart RH, Slump CH, Dierckx RA, Boellaard R (2019) Repeatability of 18F-FDG PET radiomic features: a phantom study to explore sensitivity to image reconstruction settings, noise, and delineation method. Med Phys 46:665–678CrossRefPubMedGoogle Scholar
  33. 33.
    Boellaard R (2009) Standards for PET image acquisition and quantitative data analysis. J Nucl Med 50(Suppl 1):11S–20SCrossRefPubMedGoogle Scholar
  34. 34.
    Husmann L, Huellner MW, Ledergerber B, Anagnostopoulos A, Stolzmann P, Sah BR, Burger IA, Rancic Z, Hasse B, the Vasgra Cohort (2019) Comparing diagnostic accuracy of 18F-FDG-PET/CT, contrast enhanced CT and combined imaging in patients with suspected vascular graft infections. Eur J Nucl Med Mol Imaging 46(6):1359-1368. CrossRefPubMedGoogle Scholar
  35. 35.
    Legout L, D’Elia PV, Sarraz-Bournet B, Haulon S, Meybeck A, Senneville E, Leroy O (2012) Diagnosis and management of prosthetic vascular graft infections. Med Mal Infect 42(3):102–109CrossRefPubMedGoogle Scholar
  36. 36.
    Keidar Z, Pirmisashvili N, Leiderman M, Nitecki S, Israel O (2014) 18F-FDG uptake in noninfected prosthetic vascular grafts: incidence, patterns, and changes over time. J Nucl Med 55(3):392–395CrossRefPubMedGoogle Scholar
  37. 37.
    Husmann L, Ledergerber B, Anagnostopoulos A, Stolzmann P, Sah BR, Burger IA, Pop R, Weber A, Mayer D, Rancic Z, Hasse B, Study VC (2018) The role of FDG PET/CT in therapy control of aortic graft infection. Eur J Nucl Med Mol Imaging 45(11):1987–1997 (Study VC) CrossRefPubMedGoogle Scholar
  38. 38.
    Rabkin Z, Israel O, Keidar Z (2010) Do hyperglycemia and diabetes affect the incidence of false-negative 18F-FDG PET/CT studies in patients evaluated for infection or inflammation and cancer? A comparative analysis. J Nucl Med 51(7):1015–1020CrossRefPubMedGoogle Scholar

Copyright information

© Italian Association of Nuclear Medicine and Molecular Imaging 2019

Authors and Affiliations

  1. 1.Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
  2. 2.Department of Nuclear MedicineOdense University HospitalOdenseDenmark
  3. 3.Department of Cardiothoracic and Vascular SurgeryOdense University HospitalOdenseDenmark
  4. 4.Department of Radiology and Nuclear MedicineHospital of Southwest JutlandEsbjergDenmark
  5. 5.Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark

Personalised recommendations