The Role of FDG PET/CT in Therapy Control of Aortic Graft Infection

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2018 Jun 28

PMID 29948106

Citations 11

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

Affiliations

Soon will be listed here.

Abstract

Purpose: F-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) 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 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 log mg/L 0.05 [95% C.I. 0.02-0.08]) was associated with higher SUV. CRP, metabolic and clinical findings informed the decision to either start (medians of SUV 7.1 and CRP 31.5 mg/L; 100% focal uptake), escalate (SUV 9.5; CRP 31.5; 100% focal uptake), continue (SUV 6.0; CRP 9.95 mg/L; 90% focal uptake), or stop (SUV 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. CLINICALTRIALS.

Gov Identifier: NCT01821664.

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References

Spacek M, Belohlavek O, Votrubova J, Sebesta P, Stadler P . Diagnostics of "non-acute" vascular prosthesis infection using 18F-FDG PET/CT: our experience with 96 prostheses. Eur J Nucl Med Mol Imaging. 2008; 36(5):850-8. DOI: 10.1007/s00259-008-1002-z. View

Deipolyi A, Rho J, Khademhosseini A, Oklu R . Diagnosis and management of mycotic aneurysms. Clin Imaging. 2016; 40(2):256-62. DOI: 10.1016/j.clinimag.2015.11.011. View

Turtiainen J, Saimanen E, Partio T, Karkkainen J, Kiviniemi V, Makinen K . Surgical wound infections after vascular surgery: prospective multicenter observational study. Scand J Surg. 2010; 99(3):167-72. DOI: 10.1177/145749691009900312. View

Fiorani P, Speziale F, Rizzo L, De Santis F, Massimi G, Taurino M . Detection of aortic graft infection with leukocytes labeled with technetium 99m-hexametazime. J Vasc Surg. 1993; 17(1):87-95; discussion 95-6. View

Kagna O, Kurash M, Ghanem-Zoubi N, Keidar Z, Israel O . Does Antibiotic Treatment Affect the Diagnostic Accuracy of F-FDG PET/CT Studies in Patients with Suspected Infectious Processes?. J Nucl Med. 2017; 58(11):1827-1830. DOI: 10.2967/jnumed.117.192062. View

Machelart I, Greib C, Wirth G, Camou F, Issa N, Viallard J . Graft infection after a Bentall procedure: A case series and systematic review of the literature. Diagn Microbiol Infect Dis. 2017; 88(2):158-162. DOI: 10.1016/j.diagmicrobio.2017.03.002. View

Low R, Wall S, Jeffrey Jr R, Sollitto R, Reilly L, Tierney Jr L . Aortoenteric fistula and perigraft infection: evaluation with CT. Radiology. 1990; 175(1):157-62. DOI: 10.1148/radiology.175.1.2315475. View

Fukuchi K, Ishida Y, Higashi M, Tsunekawa T, Ogino H, Minatoya K . Detection of aortic graft infection by fluorodeoxyglucose positron emission tomography: comparison with computed tomographic findings. J Vasc Surg. 2005; 42(5):919-25. DOI: 10.1016/j.jvs.2005.07.038. View

Bruggink J, Glaudemans A, Saleem B, Meerwaldt R, Alkefaji H, Prins T . Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endovasc Surg. 2010; 40(3):348-54. DOI: 10.1016/j.ejvs.2010.05.016. View

10.

Seban R, Bonardel G, Guernou M, Lussato D, Queneau M . The Use of FDG PET-CT Imaging for the Assessment of Early Antifungal Treatment Response in Disseminated Fusariosis. Clin Nucl Med. 2017; 42(7):569-570. DOI: 10.1097/RLU.0000000000001682. View

11.

Mayer D, Hasse B, Koelliker J, Enzler M, Veith F, Rancic Z . Long-term results of vascular graft and artery preserving treatment with negative pressure wound therapy in Szilagyi grade III infections justify a paradigm shift. Ann Surg. 2011; 254(5):754-59. DOI: 10.1097/SLA.0b013e3182365864. View

12.

Rabkin Z, Israel O, Keidar Z . Do hyperglycemia and diabetes affect the incidence of false-negative 18F-FDG PET/CT studies in patients evaluated for infection or inflammation and cancer? A Comparative analysis. J Nucl Med. 2010; 51(7):1015-20. DOI: 10.2967/jnumed.109.074294. View

13.

Husmann L, Sah B, Scherrer A, Burger I, Stolzmann P, Weber R . ¹⁸F-FDG PET/CT for Therapy Control in Vascular Graft Infections: A First Feasibility Study. J Nucl Med. 2015; 56(7):1024-9. DOI: 10.2967/jnumed.115.156265. View

14.

Chacko A, Watanabe S, Herr K, Kalimuddin S, Tham J, Ong J . 18F-FDG as an inflammation biomarker for imaging dengue virus infection and treatment response. JCI Insight. 2017; 2(9). PMC: 5414563. DOI: 10.1172/jci.insight.93474. View

15.

Sah B, Husmann L, Mayer D, Scherrer A, Rancic Z, Puippe G . Diagnostic performance of 18F-FDG-PET/CT in vascular graft infections. Eur J Vasc Endovasc Surg. 2015; 49(4):455-64. DOI: 10.1016/j.ejvs.2014.12.024. View

16.

Hasse B, Husmann L, Zinkernagel A, Weber R, Lachat M, Mayer D . Vascular graft infections. Swiss Med Wkly. 2013; 143:w13754. DOI: 10.4414/smw.2013.13754. View

17.

Samson R, Veith F, Janko G, Gupta S, Scher L . A modified classification and approach to the management of infections involving peripheral arterial prosthetic grafts. J Vasc Surg. 1988; 8(2):147-53. View

18.

Keidar Z, Pirmisashvili N, Leiderman M, Nitecki S, Israel O . 18F-FDG uptake in noninfected prosthetic vascular grafts: incidence, patterns, and changes over time. J Nucl Med. 2014; 55(3):392-5. DOI: 10.2967/jnumed.113.128173. View

19.

Vogel T, Symons R, Flum D . The incidence and factors associated with graft infection after aortic aneurysm repair. J Vasc Surg. 2008; 47(2):264-9. DOI: 10.1016/j.jvs.2007.10.030. View

20.

Lyons O, Baguneid M, Barwick T, Bell R, Foster N, Homer-Vanniasinkam S . Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC). Eur J Vasc Endovasc Surg. 2016; 52(6):758-763. DOI: 10.1016/j.ejvs.2016.09.007. View