![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT)](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
Diagnostics of "non-acute" vascular prosthesis infection using 18F-FDG PET/CT: our experience with 96 prostheses
M Spacek1, O Belohlavek, J Votrubova
1Second Clinical Department of Cardiovascular Surgery, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic. mirekspacek@seznam.cz
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 (18)F-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.
Insights
Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) accurately detects vascular prosthesis infection (VPI). Focal uptake and irregular graft borders are key indicators, offering high diagnostic accuracy for this life-threatening complication.
Area of Science:
- Nuclear medicine
- Radiology
- Infectious disease diagnostics
Background:
- Vascular prosthesis infection (VPI) is a serious complication affecting 0.5-5% of patients.
- Diagnosing low-grade VPI in non-acute patients presents a significant challenge.
- A need exists for accurate diagnostic methods for suspected VPI.
Purpose of the Study:
- To evaluate the diagnostic accuracy of (18)F-FDG PET/CT for VPI.
- To identify key parameters for accurate VPI diagnosis using PET/CT.
Main Methods:
- Prospective PET/CT scans in 96 vascular grafts across 76 patients with suspected VPI.
- Analysis of FDG uptake (focal/diffuse, intensity), pseudoaneurysm, and lesion boundary characteristics.
- Gold standard: operative findings, histopathology, or >6 months clinical follow-up.
Main Results:
- Focal FDG uptake and irregular graft boundaries were significant predictors of VPI.
- Combined focal uptake and irregular borders predicted VPI with 97% probability.
- Even with non-diagnostic uptake, irregular boundaries improved VPI probability (77% vs. 28% for smooth).
Conclusions:
- PET/CT demonstrated high diagnostic accuracy (>95%) in 75% of cases.
- PET/CT identified prostheses with diminished accuracy (70-75%) in 25% of cases.
- PET/CT is an excellent modality for diagnosing suspected VPI.
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