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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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

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Fig. 1

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. https://doi.org/10.1371/journal.pmed1000097

Fig. 2

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Acknowledgements

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

Funding

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

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Authors and Affiliations

  1. Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

    Synnøve Klyve Sunde & Therese Beske

  2. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

    Oke Gerke

  3. Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark

    Lene Langhoff Clausen

  4. Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Finsensgade 35, 6700, Esbjerg, Denmark

    Søren Hess

  5. Department of Regional Health Research, University of Southern Denmark, Odense, Denmark

    Søren Hess

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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.

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Correspondence to Søren Hess.

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40336_2019_336_MOESM1_ESM.pdf

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. https://doi.org/10.1371/journal.pmed1000097. (PDF 154 kb)

Supplementary material 2 Funnel plots (PDF 968 kb)

Supplementary material 3 SROC-curve for focal uptake (TIFF 1886 kb)

Supplementary material 4 (DOCX 17 kb)

Supplementary material 5 (DOCX 13 kb)

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Sunde, S.K., Beske, T., Gerke, O. et al. FDG-PET/CT as a diagnostic tool in vascular graft infection: a systematic review and meta-analysis. Clin Transl Imaging 7, 255–265 (2019). https://doi.org/10.1007/s40336-019-00336-1

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  • DOI: https://doi.org/10.1007/s40336-019-00336-1

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