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Diagnostic performance of quantitative and qualitative parameters for the diagnosis of aortic graft infection using [18F]-FDG PET/CT

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

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.

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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

  1. 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.

    PubMed  Google Scholar 

  2. 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.

    Article  CAS  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  CAS  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  CAS  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. 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.

    Article  CAS  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Article  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Chapter  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. 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.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Ingo Einspieler MD, Victor Mergen MD, Matthias Eiber MD, Markus Schwaiger MD, Stephan G. Nekolla PhD & Mona Mustafa MD

  2. Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Ingo Einspieler MD

  3. Vascular Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Heiko Wendorff MD

  4. Medical Statistics and Epidemiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Bernhard Haller PhD

  5. Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. Partner site Munich Heart Alliance, Munich, Germany

    Markus Schwaiger MD & Stephan G. Nekolla PhD

Authors
  1. Ingo Einspieler MD
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  2. Victor Mergen MD
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Correspondence to Ingo Einspieler MD.

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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

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