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European Journal of Nuclear Medicine and Molecular Imaging

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01-05-2009 | Original Article

Diagnostics of “non-acute” vascular prosthesis infection using ¹⁸F-FDG PET/CT: our experience with 96 prostheses

Authors: M. Spacek, O. Belohlavek, J. Votrubova, P. Sebesta, P. Stadler

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 5/2009

Abstract

Introduction

Vascular prosthesis infection (VPI) is a life-threatening complication that occurs in 0.5–5% of prostheses. Low-grade infections in non-acute patients are a diagnostic challenge requiring a new method with good diagnostic accuracy. The aim of this work was to define the accuracy of ¹⁸F-FDG PET/CT in these settings and to identify essential parameters of the evaluation.

Material and methods

PET/CT was performed prospectively in 76 consecutive patients with a total of 96 vascular prosthetic grafts in which infection was suspected. PET/CT scans were analysed in terms of the presence and intensity of focal and diffuse FDG uptake, the presence of an anastomotic pseudoaneurysm, the presence of an irregular boundary of infiltration, a combination of these, and the uptake ratio between the graft and blood background. The gold standard was based on operative/histopathological finding or a clinical follow up of >6 months.

Results

Among the various assessed parameters only focal FDG uptake and an irregular graft boundary were significant predictors of VPI. Focal intense FDG uptake together with an irregular boundary of the lesion on CT scan predicted VPI with 97% probability, while smooth lesion boundaries and no focal FDG uptake predicted a probability of VPI of less than 5%. Even in lesions with nondiagnostic inhomogeneous focal FDG uptake (18/96) an irregular boundary effectively helped in decision-making with a probability of 28% (smooth) or 77% (irregular) for VPI.

Conclusion

PET/CT gave reliable results with an accuracy >95% in 75% of prostheses. PET/CT can identify those prostheses (25% of prosthesis) for which its diagnostic accuracy is diminished to 70–75%. In our series PET/CT was an excellent diagnostic modality for suspected VPI.

Hallett JW, Marshall DM, Petterson TM, et al. Graft related complications after abdominal aortic aneurysm repair. Population based experience. J Vasc Surg 1977;25:277.CrossRef

Bandyk DF. Infection of prosthetic vascular grafts. In: Rutherford RB, editor. Vascular surgery. 5th ed. St. Louis, CV Mosby; 1995. p. 566

Orton D, LeVeen R, Saigh J, et al. Aortic prosthetic graft infections: radiologic manifestations and implications for management. Radiographics 2000;20:977–93.PubMed

Low R, Wall S, Jeffrey R, et al. Aortoenteric fistula and perigraft infection evaluation with CT. Radiology 1990;175:157–62.PubMed

Olofsson P, Auffermann W, Higgins C, et al. Diagnosis of prosthetic graft infection by magnetic resonance imaging. J Vasc Surg 1988;8:99–105.PubMedCrossRef

Spartera C, Morettini G, Petrassi C. Healing of aortic prosthetic grafts: a study by magnetic resonance imaging. Ann Vasc Surg 1994;8:536–42.PubMedCrossRef

Spartera C, Morettini G, Petrassi C. Role of magnetic resonance imaging in the evaluation of aortic graft healing, perigraft fluid collection, and graft infection. Eur J Vasc Surg 1990;4:69–73.PubMedCrossRef

Lawrence P, Dries D, Alazraki N, et al. Indium 111-labeled leucocyte scanning for detection of prosthetic vascular graft infection. J Vasc Surg 1985;2:165–73.PubMedCrossRef

Sedwitz M, Davies R, Pretorius H, Vasquez TE. Indium 111-labeled white blood cell scans after vascular prosthetic reconstruction. J Vasc Surg 1987;6:476-81.PubMedCrossRef

10.

Fiorani P, Speziale F, Rizzo L, et al. Detection of aortic graft infection with leucocytes labeled with technetium 99m-hexametazime. J Vasc Surg 1993;17:87–95.PubMedCrossRef

11.

Liberatore M, Iurilli A, Ponzo F, et al. Clinical usefulness of technetium-99m-HMPAO labeled leucocyte scans in prosthetic vascular graft infection. J Nucl Med 1998;39:875–9.PubMed

12.

Prats E, Banzo J, Abos M, et al. Diagnosis of prosthetic vascular graft infection by technetium-99m-HMPAO labeled leucocytes. J Nucl Med 1994;35:1303–7.PubMed

13.

Krznaric E, Nevelsteen A, van Hoe L, et al. Diagnostic value of 99Tc-HMPAO labelled leucocyte scintigraphy in the detection of vascular graft infections. Nucl Med Commun 1994;15:953–960.PubMed

14.

Causey DA, Fajman WA, Perdue GD, et al. 67Ga scintigraphy in postoperative synthetic graft infection. AJR Am J Roentgenol 1980;134:1041–5.PubMed

15.

Johnson K, Russ PD, Bair JH, Friefeld GD. Diagnosis of synthetic vascular graft infection: comparison of CT and gallium scans. Am J Roentgenol 1990;154:405–9.PubMed

16.

Samuel A, Paganelli G, Chiesa R, et al. Detection of prosthetic vascular graft infection using avidin/indium-111-biotin scintigraphy. J Nucl Med 1996;37:55–61.PubMed

17.

Chiesa R, Melissano G, Castellano R, et al. Avidin and 111In-labeled biotin scan: a new radioisotopic method for localising vascular graft infection. Eur J Vasc Endovasc Surg 1995;10:405–14.PubMedCrossRef

18.

Mark A, Moss A, Lusby R, et al. CT evaluation of complications of abdominal aortic surgery. Radiology 1982;145:409–44.PubMed

19.

Lauwers P, Van den Broeck S, Carp L, et al. The use of positron emission tomography with (18)F-fluorodeoxyglucose for the diagnosis of vascular graft infection. Angiology 2007;58:717–24.PubMedCrossRef

20.

Balink H, Reijnen MM. Diagnosis of abdominal aortic prosthesis infection with FDG-PET/CT. Vasc Endovascular Surg 2007;41:428–32.PubMedCrossRef

21.

Burroni L, D’Alessandria C, Signore A. Diagnosis of vascular prosthesis infection: PET or SPECT. J Nucl Med 2007;48:1227–9.PubMedCrossRef

22.

Tegler G, Sörensen J, Björck M, et al. Detection of aortic graft infection by 18-fluorodeoxyglucose positron emission tomography combined with computed tomography. J Vasc Surg 2007;45:828–30.PubMedCrossRef

23.

Stadler P, Belohlavek O, Spacek M, Michalek P. Diagnosis of vascular prosthesis infection with FDG-PET/CT. J Vasc Surg 2004;40:1246–7.PubMedCrossRef

24.

Rohde H, Horstkotte MA, Loeper S, et al. Recurrent Listeria monocytogenes aortic graft infection: confirmation of relapse by molecular subtyping. Diagn Microbiol Infect Dis 2004;48:63–7.PubMedCrossRef

25.

Krupnick AS, Lombardi JV, Engels FH, et al. 18-fluorodeoxyglucose positron emission tomography as a novel imaging tool for the diagnosis of aortoenteric fistula and aortic graft infection-a case report. Vasc Endovascular Surg 2003;37:363–6.PubMedCrossRef

26.

Keidar Z, Engel A, Nitecki S, et al. PET/CT using 2-deoxy-2-[18F]fluoro-D-glucose for the evaluation of suspected infected vascular graft. Mol Imaging Biol 2003;5:23–5.PubMedCrossRef

27.

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;42:919–25.PubMedCrossRef

28.

Bleeker-Rovers CP, Vos FJ, Corstens FH, Oyen WJ. Imaging of infectious diseases using [18F] fluorodeoxyglucose PET. Q J Nucl Med Mol Imaging 2008;52:17–29.PubMed

29.

Jaruskova M, Belohlavek O. Role of FDG-PET and PET/CT in the diagnosis of prolonged febrile states. Eur J Nucl Med Mol Imaging 2006;33:913–8.PubMedCrossRef

30.

Keidar Z, Engel A, Hoffman A, et al. Prosthetic vascular graft infection: the role of 18F-FDG PET/CT. J Nucl Med 2007;48:1230–6.PubMedCrossRef

31.

Yeager RA, Porter JM. Arterial and prosthetic graft infection. Ann Vasc Surg 1992;6:485–91.PubMedCrossRef

32.

Sundaram B, Quint LE, Patel S, et al. CT appearance of thoracic aortic graft complications. AJR Am J Roentgenol 2007;188:1273–7.PubMedCrossRef

33.

Yamamoto K, Noishiki Y, Mo M, et al. Unusual inflammatory responses around a collagen-impregnated vascular prosthesis. Artif Organs 1993;17:1010–6.PubMedCrossRef

34.

Oechslin E, Carrel T, Ritter M, et al. Pseudoaneurysm following aortic homograft: clinical implications. Br Heart J 1995;74:645–9.PubMedCrossRef

35.

Willems TP, Van Herwerden LA, Taams MA, et al. Aortic allograft implantation techniques: pathomorphology and regurgitant jet patterns by Doppler echocardiographic studies. Ann Thorac Surg 1998;66:412–6.PubMedCrossRef

36.

Macedo TA, Stanson AW, Oderich SG, et al. Infected aortic aneurysms: imaging findings. Radiology 2004;231:250–7.PubMedCrossRef

Title: Diagnostics of “non-acute” vascular prosthesis infection using 18F-FDG PET/CT: our experience with 96 prostheses
Authors: M. Spacek
O. Belohlavek
J. Votrubova
P. Sebesta
P. Stadler
Publication date: 01-05-2009
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 5/2009
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-008-1002-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostics of “non-acute” vascular prosthesis infection using ¹⁸F-FDG PET/CT: our experience with 96 prostheses

Abstract

Introduction

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Material and methods

Results

Conclusion

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