Clinical experience of positron-emission tomography in infective aortic disease

Background Fluorine-18-fluorodeoxyglucose positron-emission tomography with computed tomography has revolutionized medical diagnosis by adding functional activity to anatomic imaging. We report our experience with this technique in patients with mycotic aortic pathology and aortic vascular graft infection. Methods We conducted a retrospective review of a prospective database of patients who underwent ¹⁸F-fluorodeoxyglucose positron-emission tomography with computed tomography for suspected infective aortic disease. From 2012 to 2016, 13 patients underwent ¹⁸F-fluorodeoxyglucose positron-emission tomography. Of these, 9 (69%) had a vascular graft infection (5 infrarenal aorta, 1 para-visceral, 2 descending, and 1 arch; 2 had previous open surgery and 7 had endovascular interventions) and 4 (31%) had a mycotic aneurysm (2 aortic arch, 1 infrarenal aorta, and 1 distal aorta and common iliac; 3 had endografts). The indications for imaging, location of pathology, ¹⁸F uptake, and clinical outcomes were analyzed. Results Eight (62%) patients had a single scan and 5 (38%) had serial scans performed. Among the 5 patients who had serial imaging, 3 showed decreased ¹⁸F uptake and 2 had increased uptake. Only one patient underwent subsequent endograft removal; the others were treated with lifelong antibiotics. There were 5 (38%) deaths on follow-up. Conclusion ¹⁸F-fluorodeoxyglucose positron-emission tomography with computed tomography could be a valuable adjunct in the diagnosis and surveillance of patients with aortic infection. Serial scans may be useful for monitoring disease activity and response to antibiotic therapy.