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Prosthetic vascular graft infection: A systematic review and meta-analysis on diagnostic accuracy of 18FDG PET/CT

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Abstract

Introduction

There is a high risk of mortality and morbidity associated with Vascular Graft Infections (VGI) which requires early diagnosis. The aim of the present systematic review and meta-analysis was to evaluate the diagnostic accuracy, sensitivity and specificity of 18FDG PET/CT in diagnosing VGI.

Methods

A systematic review was conducted according to the PRISMA guidelines through a search in Embase, PubMed, and Cochrane databases. We evaluated five parameters including specificity, sensitivity, negative and positive predictive values (NPV and PPV), and accuracy. We used STATA/MP 15.0 (StataCorp, College Station, TX) for all of our analyses.

Results

Overall 10 studies including 320 patients undergone 18FDG PET/CT were included. The sensitivity, specificity, positive and negative likelihood ratios along with their 95% CI were 0.92 (95% CI 0.88–0.95), 0.76 (95% CI 0.76–0.70), 3.49 (95% CI 3.49–2.32) and 0.14 (95% CI 0.09–0.23), respectively. The diagnostic odds ratio (DOR) for diagnosis of VGI was 37.12 (95% CI 14.84–92.82). The mean cut-off value of the maximum standardized uptake value (SUVmax) for diagnosis of VGI was 5.39 while the overall mean SUVmax among patients with VGI was 8.47.

Conclusion

According to our results, 18FDG PET/CT is a useful diagnostic method in detecting active VGI with high diagnostic accuracy. Because of its ability to evaluate morphology and main texture using SUVmax, the 18FDG PET/CT provides an objective assessment of aspects and extent of disease activity, which results in preventing unnecessary surgery, proper treatment planning, and evaluating the effectiveness of treatment.

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References

  1. Hallett JW Jr, Marshall DM, Petterson TM, et al. Graft-related complications after abdominal aortic aneurysm repair: reassurance from a 36-year population-based experience. J Vasc Surg. 1997;25(2):277–84 (discussion 285–286).

    PubMed  Google Scholar 

  2. Wilson WR, Bower TC, Creager MA, et al. Vascular graft infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412–60.

    PubMed  Google Scholar 

  3. Hasse B, Husmann L, Zinkernagel A, Weber R, Lachat M, Mayer D. Vascular graft infections. Swiss Med Wkly. 2013;143:W13754.

    PubMed  Google Scholar 

  4. Keidar Z, Nitecki S. FDG-PET in prosthetic graft infections. Semin Nucl Med. 2013;43(5):396–402.

    PubMed  Google Scholar 

  5. Lyons OT, Baguneid M, Barwick TD, 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(6):758–63.

    CAS  PubMed  Google Scholar 

  6. Fukuchi K, Ishida Y, Higashi M, et al. Detection of aortic graft infection by fluorodeoxyglucose positron emission tomography: comparison with computed tomographic findings. J Vasc Surg. 2005;42(5):919–25.

    PubMed  Google Scholar 

  7. Keidar Z, Engel A, Hoffman A, Israel O, Nitecki S. Prosthetic vascular graft infection: the role of 18FDG PET/CT. J Nucl Med. 2007;48(8):1230–6.

    PubMed  Google Scholar 

  8. Spacek M, Belohlavek O, Votrubova J, Sebesta P, Stadler P. Diagnostics of “non-acute” vascular prosthesis infection using 18F-FDG PET/CT: our experience with 96 prostheses. Eur J Nucl Med Mol Imaging. 2009;36(5):850–8.

    CAS  PubMed  Google Scholar 

  9. Bruggink JL, Glaudemans AW, Saleem BR, et al. Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endovasc Surg. 2010;40(3):348–54.

    CAS  PubMed  Google Scholar 

  10. Sah BR, Husmann L, Mayer D, et al. Diagnostic performance of F- FDG-PET/CT in vascular graft infections. Eur J Vasc Endovasc Surg. 2015;49(4):455–64.

    PubMed  Google Scholar 

  11. Tokuda Y, Oshima H, Araki Y, et al. Detection of thoracic aortic prosthetic graft infection with 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Eur J Cardiothorac Surg. 2013;43(6):1183–7.

    PubMed  Google Scholar 

  12. Stumpe KD, Dazzi H, Schaffner A, von Schulthess GK. Infection imaging using whole-body FDG-PET. Eur J Nucl Med. 2000;27(7):822–32.

    CAS  PubMed  Google Scholar 

  13. Low RN, Wall SD, Jeffrey RB Jr, Sollitto RA, Reilly LM, Tierney LM Jr. Aortoenteric fistula and perigraft infection: evaluation with CT. Radiology. 1990;175(1):157–62.

    CAS  PubMed  Google Scholar 

  14. Bruggink JL, Slart RH, Pol JA, Reijnen MM, Zeebregts CJ. Current role of imaging in diagnosing aortic graft infections. Semin Vasc Surg. 2011;24(4):182–90.

    PubMed  Google Scholar 

  15. Keidar Z, Pirmisashvili N, Leiderman M, Nitecki S, Israel O. 18F- FDG uptake in noninfected prosthetic vascular grafts: incidence, patterns, and changes over time. J Nucl Med. 2014;55(3):392–5.

    CAS  PubMed  Google Scholar 

  16. Husmann L, Hasse B. PET-CT in vascular graft infections. Zentralbl Chir. 2017;142(5):502–5.

    PubMed  Google Scholar 

  17. Pfannenberg AC, Aschoff P, Brechtel K, et al. Value of contrast- enhanced multiphase CT in combined PET/CT protocols for onco- logical imaging. Br J Radiol. 2007;80(954):437–45.

    CAS  PubMed  Google Scholar 

  18. Saleem BR, Berger P, Vaartjes I, et al. Modest utility of quantitative measures in F-fluorodeoxyglucose positron emissiontomography scanning for the diagnosis of aortic prosthetic graft infection. J Vasc Surg. 2014;61(4):965–71.

    PubMed  Google Scholar 

  19. Baddour L, Bettmann M, Bolger A, Epstein AE, Ferrieri P, Gerber MA, et al. Nonvalvular cardiovascular device-related infections. Circulation. 2003;108:2015–31.

    PubMed  Google Scholar 

  20. Orton D, LeVeen R, Saigh J, Culp WC, Fidler JL, Lynch TJ, et al. Aortic prosthetic graft infections: Radiologic manifestations and implications for management. Radiographics. 2000;20:977–93.

    CAS  PubMed  Google Scholar 

  21. Low R, Wall S, Jeffrey R, Sollitto RA, Reilly LM, Tierney LMJ. Aortoenteric fistula and perigraft infection evaluation with CT. Radiology. 1990;175:157–62.

    CAS  PubMed  Google Scholar 

  22. Erba PA, Leo G, Sollini M, Tascini C, Boni R, Berchiolli RN, et al. Radiolabelled leucocyte scintigraphy versus conventional radiologi- cal imaging for the management of late, low-grade vascular prosthesis infections. Eur J Nucl Med Mol Imaging. 2014;41:357–68.

    CAS  PubMed  Google Scholar 

  23. Wasselius J, Malmstedt J, Kalin B, Larsson S, Sundin A, Hedin U, et al. High 18F-FDG Uptake in synthetic aortic vascular grafts onPET/CT in symptomatic and asymptomatic patients. J Nucl Med. 2008;49:1601–5.

    PubMed  Google Scholar 

  24. Keidar Z, Engel A, Hoffman A, Israel O, Nitecki S. Prosthetic vascular graft infection: the role of 18F-FDG PET/CT. J Nucl Med. 2007;48:1230–6.

    PubMed  Google Scholar 

  25. Brugging JL, Glaudemans AW, Saleem BR, Meerwaldt R, Alke- faji H, Prins TR, et al. Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endo Vasc Surg. 2010;40:348–54.

  26. Spacek M, Belohlavek O, Votrubova J, Sebesta P, Stadler P. Diagnostics of ‘“non-acute”’ vascular prosthesis infection using 18F-FDG PET/CT: our experience with 96 prostheses. Eur J Nucl Med Mol Imaging. 2009;36:850–8.

    CAS  PubMed  Google Scholar 

  27. Berger P, Vaartjes I, Scholtens A, Moll FL, De Borst GJ, De Keizer B, et al. Differential FDG-PET uptake patterns in unin- fectedand infected central prosthetic vascular grafts. Eur J Vasc Endovasc Surg. 2015;50:376–83.

    CAS  PubMed  Google Scholar 

  28. Schouten LR, Verberne HJ, Bouma BJ, van Eck-Smit BL, Mulder BJ. Surgical glue for repair of the aortic root as a possible explanation for increased F-18 FDG uptake. J Nucl Cardiol. 2008;15:146–7.

    PubMed  Google Scholar 

  29. Guenther SP, Cyran CC, Rominger A, Saam T, Kazmierzcak PM, Bagaev E, et al. The relevance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in diagnos- ing prosthetic graft infections post cardiac and proximal thoracic aortic surgery. Interact Cardiovasc Thorac Surg. 2015;21:450–8.

    PubMed  Google Scholar 

  30. Nidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.

    Google Scholar 

  31. Harris R, Bradburn M, Deeks J, Harbord R, Altman D, Sterne J. Metan: fixed-and random-effects meta-analysis. Stat J. 2008;8(1):3.

    Google Scholar 

  32. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measur- ing inconsistency in meta-analyses. BMJ. 2003;327(7414):557.

    PubMed  PubMed Central  Google Scholar 

  33. Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54(10):1046–55.

    CAS  PubMed  Google Scholar 

  34. Sterne JA, Egger M, Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ. 2001;323(7304):101.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Sterne JA, Harbord RM. Funnel plots in meta-analysis. Stat J. 2004;4:127–41.

    Google Scholar 

  36. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Chu H, Cole SR. Bivariate meta-analysis of sensitiv- ity and specificity with sparse data: a generalized linear mixed model approach. J Clin Epidemiol. 2006;59(12):1331–2. https://doi.org/10.1016/j.jclinepi.2006.06.011.

    Article  PubMed  Google Scholar 

  38. Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwin- derman AH, . Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 2005;58(10):982–90. https://doi.org/10.1016/j.jclinepi.2005.02.022.

    Article  PubMed  Google Scholar 

  39. Gardet E, Addas R, Monteil J, Le Guyader A. Comparison of detection of F-18 fluorodeoxyglucose positron emission to- mography and 99mTc-hexamethylpropylene amine oxime labelled leukocyte scintigraphy for an aortic graft infection. Interact Cardiovasc Thorac Surg. 2010;10:142–3.

    PubMed  Google Scholar 

  40. Folmer EI, von Meijenfeldt GC, van der Laan MJ, Glaudemans AW, Slart RH, Zeebregts CJ, Saleem BR. A systematic review and meta-analysis of 18F-fluoro-d-deoxyglucose positron emission tomography interpretation methods in vascular graft and endograft infection. J Vas Surg. 2020;72(6):2174–85.

  41. Tayama E, Hori H, Ueda T, Kono T, Imasaka K, Harada T, et al. Usefulness of 18F-FDG-PET/CT in aortic graft infection: two cases. J Cardiothorac Surg. 2014;9:42.

    PubMed  PubMed Central  Google Scholar 

  42. Folmer EI, Von Meijenfeldt GC, Van der Laan MJ, Glaudemans AW, Slart RH, Saleem BR, Zeebregts CJ. Diagnostic imaging in vascular graft infection: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2018;56(5):719–29.

    Google Scholar 

  43. Fukuchi K, Ishida Y, Higashi M, Tsunekawa T, Ogino H, Minatoya K, et al. Detection of aortic graft infection by flu- orodeoxyglucose positron emission tomography: compari- son with computed tomographic findings. J Vasc Surg. 2005;42:919–25.

    PubMed  Google Scholar 

  44. Perera GB, Fujitani RM, Kubaska SM. Aortic graft infection: update on management and treatment options. Vasc Endovascular Surg. 2006;40(1):1–10.

    PubMed  Google Scholar 

  45. Orton DF, LeVeen RF, Saigh JA, et al. Aortic prosthetic graft infections: radiologic manifestations and implications for management. Radiographics. 2000;20(4):977–93.

    CAS  PubMed  Google Scholar 

  46. Malone JM, Moore WS, Campagna G, Bean B. Bacteremic infectability of vascular grafts: the influence of pseudointimal integrity and duration of graft function. Surgery. 1975;78(2):211–6.

    CAS  PubMed  Google Scholar 

  47. De Winter F, Vogelaers D, Gemmel F, Dierckx RA. Promising role of 18-F-fluoro-D- deoxyglucose positron emission tomography in clinical infectious diseases. Eur J Clin Microbiol Infect Dis. 2002;21(4):247–57.

    PubMed  Google Scholar 

  48. Jørgensen JJ, Skjennald A. Computer tomography after reconstructive vascular surgery of the abdominal aorta. Can fluid around the aortic prosthesis be considered a normal finding? [in Norwegian] Tidsskr Nor Laegeforen. 1992;112(13):1697–1699.

  49. Johnson KK, Russ PD, Bair JH, Friefeld GD. Diagnosis of synthetic vascular graft infection: comparison of CT and gallium scans. AJR Am J Roentgenol. 1990;154(2):405–9.

    CAS  PubMed  Google Scholar 

  50. Van Assen S, Houwerzijl EJ, van den Dungen JJ, Koopmans KP. Vascular graft infection due to chronic Q fever diagnosed with fusion positron emission tomography/computed tomography. J Vasc Surg. 2007;46(2):372.

    PubMed  Google Scholar 

  51. Varino Sousa J, Antunes L, Mendes C, Marinho A, Gonçalves A, Gonçalves O, et al. Prosthetic vascular graft infections: A center experience. Angiologia e Cirurgia Vascular. 2014;10(2):52–5.

    Google Scholar 

  52. Tegler G, Sörensen J, Björck M, Savitcheva I, Wanhainen A. Detection of aortic graft infection by 18-fluorodeoxyglucose positron emission tomography combined with computed tomography. J Vasc Surg. 2007;45(4):828–30.

    PubMed  Google Scholar 

  53. Šaponjski J, Šobić-Šaranović D, Petrović N, Odalović S, Artiko V, Stojiljković M, Ranković N, Veljković M, Vukićević M, Bogosavljević N, Jeremić D. Hybrid imaging of vascular graft infection by positron emission tomography with computed tomography using fluorine-18-labeled fluorodeoxyglucose: the Serbian National PET Center experience. Srp Arh Celok Lek. 2019;147(7–8):405–9.

    Google Scholar 

  54. Husmann L, Huellner MW, Ledergerber B, Anagnostopoulos A, Stolzmann P, Sah BR, Burger IA, Rancic Z, Hasse B. 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. 2019;46(6):1359–68.

    CAS  PubMed  Google Scholar 

  55. Puges M, Bérard X, Ruiz JB, Debordeaux F, Desclaux A, Stecken L, Pereyre S, Hocquelet A, Bordenave L, Pinaquy JB, Cazanave C. Retrospective study comparing WBC scan and 18F-FDG PET/CT in patients with suspected prosthetic vascular graft infection. Eur J Vasc Endovasc Surg. 2019;57(6):876–84.

    PubMed  Google Scholar 

  56. Bowles H, Ambrosioni J, Mestres G, Hernández-Meneses M, Sánchez N, Llopis J, Yugueros X, Almela M, Moreno A, Riambau V, Fuster D. Diagnostic yield of 18 F-FDG PET/CT in suspected diagnosis of vascular graft infection: A prospective cohort study. J Nucl Cardiol. 2020;27(1):294–302.

    PubMed  Google Scholar 

  57. Einspieler I, Mergen V, Wendorff H, Haller B, Eiber M, Schwaiger M, Nekolla SG, Mustafa M. Diagnostic performance of quantitative and qualitative parameters for the diagnosis of aortic graft infection using [18 F]-FDG PET/CT. J Nucl Cardiol. 2020;6:1–9.

    Google Scholar 

  58. Mitra A, Pencharz D, Davis M, Wagner T. Determining the diagnostic value of 18F-Fluorodeoxyglucose positron emission/computed tomography in detecting prosthetic aortic graft infection. Ann Vasc Surg. 2018;53:78–85.

    PubMed  Google Scholar 

  59. Zogala D, Rucka D, Ptacnik V, Cerny V, Trnka J, Varejka P, Heller S, Lambert L. 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. 2019;33(8):594–605.

    CAS  PubMed  Google Scholar 

  60. Chang CY, Chang CP, Shih CC, Yang BH, Cheng CY, Chang CW, Chu LS, Wang SJ, Liu RS. Added value of dual-time-point 18F-FDG PET/CT with delayed imaging for detecting aortic graft infection: an observational study. Medicine. 2015;94(27):1124–28.

    Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Zabol University of Medical Sciences, Zabol, Iran

    Zohre Mahmoodi & Mahboobeh Sheikh

  2. General Physician, Zabol University of Medical Sciences, Zabol, Iran

    Morteza Salarzaei

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  1. Zohre Mahmoodi
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Mahmoodi, Z., Salarzaei, M. & Sheikh, M. Prosthetic vascular graft infection: A systematic review and meta-analysis on diagnostic accuracy of 18FDG PET/CT. Gen Thorac Cardiovasc Surg 70, 219–229 (2022). https://doi.org/10.1007/s11748-021-01682-6

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