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Comparing diagnostic accuracy of 18F-FDG-PET/CT, contrast enhanced CT and combined imaging in patients with suspected vascular graft infections

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Background

To evaluate the diagnostic accuracy of positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (PET/CT), contrast-enhanced CT (CE-CT), and a combined imaging approach (CE-PET/CT) in patients with suspected vascular graft infection (VGI).

Methods

PET/CT and CE-CT were performed prospectively in 23 patients with suspected VGI. Diagnostic accuracy for PET/CT was assessed by using previously suggested cut-off points for maximum standardized uptake values (SUVmax) measured in the vicinity of the graft. Using a new 4-point scale for visual grading, two readers independently assessed the diagnostic accuracy for CE-CT and combined CE-PET/CT. Microbiological culture, obtained after open biopsy or graft explantation, and clinical follow-up of the patients served as the standard of reference.

Results

Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of PET/CT for the diagnosis of VGI was 100%, 50%, 100%, 72.2%, and 78.3%, using the most favorable SUVmax cut-off ≥ 4.9. Respective values for CE-CT were 100%, 50%, 100%, 72.2%, and 78.3% for reader 1, and 92.3%, 80%, 88.9%, 85.7%, and 86.9% for reader 2; while respective values for combined CE-PET/CT were 100%, 70%, 100%, 81.3%, and 86.9% for reader 1, and 100%, 80%, 100%, 86.7%, and 91.3% for reader 2. Additionally, imaging provided a conclusive clinical diagnosis in patients without graft infection (i.e., other sites of infection): five of ten patients with CE-CT, six of ten patients with PET/CT, and seven of ten patients with combined CE-PET/CT.

Conclusion

The diagnostic accuracy of combined CE-PET/CT in patients with suspected VGI is very high. The combination of the high sensitivity of PET/CT in detecting metabolically active foci in infection, and the high specificity of CE-CT in detecting anatomic alterations, appears to be the reason why combined imaging outperforms stand-alone imaging in diagnosing VGI and may be supportive in future decision-making of difficult cases of suspected VGI.

Clinical Trials.gov Identifier: NCT01821664.

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Acknowledgements

We are grateful to our patients for their commitment, and thank B. Ruehe, C. Rüegg, A. Wolfensberger, U. Matt, M. Kälin, M. Greiner and R. Pop for excellent patient care. We also thank C. Müller and S. Bürgin, study nurses and C. Vögtli for administrative assistance.

The members of the Vascular Graft Cohort Study (VASGRA) are (in alphabetical order): A. Anagnostopoulos, N. Eberhard, B. Hasse (Principal investigator), L. Husmann, B. Ledergerber, M. Lachat, D. Mayer, Z. Rancic, A. Scherrer, A. Weber, R. Weber, R. Zbinden, A. Zinkernagel.

Funding

This study was financed within the framework of the Vascular Graft Cohort Study (VASGRA), supported by Swiss National Science Foundation (SNF) grant #32473B_163132/1, a SNF protected-research-time grant for clinicians #32473B_163132/2, the Vontobel Foundation, and the Rozalia Foundation (all to BH). AA is supported by the academic career program “Filling the gap” of the Medical Faculty of the University of Zurich. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital of Zurich / University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland

    Lars Husmann, Martin W. Huellner, Paul Stolzmann, Bert-Ram Sah & Irene A. Burger

  2. Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich / University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland

    Bruno Ledergerber, Alexia Anagnostopoulos & Barbara Hasse

  3. Institute of Diagnostic and Interventional Radiology, Department Medical Radiology, University Hospital of Zurich / University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland

    Bert-Ram Sah

  4. Department of Cancer Imaging, King’s College London, London, UK

    Bert-Ram Sah

  5. Clinic for Cardiovascular Surgery, University Hospital of Zurich / University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland

    Zoran Rancic

Authors
  1. Lars Husmann
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  2. Martin W. Huellner
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  3. Bruno Ledergerber
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  4. Alexia Anagnostopoulos
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  5. Paul Stolzmann
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  6. Bert-Ram Sah
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  7. Irene A. Burger
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  8. Zoran Rancic
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  9. Barbara Hasse
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and the Vasgra Cohort

Contributions

BH and LH designed the study. BL analyzed the data. LH and BH wrote the first draft, and LH, BL, AA, and BH wrote the final version of the manuscript. All investigators contributed to collection and interpretation of the data, reviewed drafts of the manuscript, and approved the final manuscript.

Corresponding author

Correspondence to Lars Husmann.

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Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board approved the study, and we obtained written informed consent from all participants (KEK-ZH-Nr. 2012–0583).

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Husmann, L., Huellner, M.W., Ledergerber, B. et al. 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, 1359–1368 (2019). https://doi.org/10.1007/s00259-018-4205-y

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  • DOI: https://doi.org/10.1007/s00259-018-4205-y

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