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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-10-2018 | Original Article

The role of FDG PET/CT in therapy control of aortic graft infection

Authors: Lars Husmann, Bruno Ledergerber, Alexia Anagnostopoulos, Paul Stolzmann, Bert-Ram Sah, Irene A. Burger, Roxana Pop, Alberto Weber, Dieter Mayer, Zoran Rancic, Barbara Hasse, the VASGRA Cohort Study

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2018

Abstract

Purpose

¹⁸F-FDG PET/CT (PET/CT) is a useful tool for the diagnosis of aortic graft infection (AGI), but has rarely been used to influence therapeutic decisions during follow-up. We aimed to study the role of PET/CT in the long-term monitoring of patients.

Methods

Participants of the prospective Vascular Graft Infection Cohort Study (VASGRA) were included if they had microbiologically proven AGI. We quantified the metabolic activity in PET/CT by using maximum standardized uptake value (SUV_max) and further classified it as being focal or diffuse. Multivariable linear regression models were fit using generalized estimating equations to investigate factors associated with SUV_max over time.

Results

Sixty-eight participants with AGI contributed to 266 PET/CTs including 36 examinations performed after stop of antimicrobial therapy. Higher C-reactive protein (CRP) (adjusted coefficient per log₁₀ mg/L 0.05 [95% C.I. 0.02–0.08]) was associated with higher SUV_max. CRP, metabolic and clinical findings informed the decision to either start (medians of SUV_max 7.1 and CRP 31.5 mg/L; 100% focal uptake), escalate (SUV_max 9.5; CRP 31.5; 100% focal uptake), continue (SUV_max 6.0; CRP 9.95 mg/L; 90% focal uptake), or stop (SUV_max 4.3; CRP 3.5 mg/L; 61% focal uptake) antibiotic treatment. Of note, decisions to escalate or continue antibiotic treatment were taken despite normal CRP values in 12.5 and 35.7% of PET/CTs, respectively.

Conclusions

Consecutive PET/CTs could influence the clinical decision-making in patients with AGI in the near future. More studies on the use of PET/CT in case of aortic graft infection may offer the potential for individualized treatment approaches.

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NCT01821664.

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Title: The role of FDG PET/CT in therapy control of aortic graft infection
Authors: Lars Husmann
Bruno Ledergerber
Alexia Anagnostopoulos
Paul Stolzmann
Bert-Ram Sah
Irene A. Burger
Roxana Pop
Alberto Weber
Dieter Mayer
Zoran Rancic
Barbara Hasse
the VASGRA Cohort Study
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-018-4069-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The role of FDG PET/CT in therapy control of aortic graft infection

Abstract

Purpose

Methods

Results

Conclusions

CLINICALTRIALS.GOV IDENTIFIER

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

CLINICALTRIALS.GOV IDENTIFIER

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