How to recognize stent graft infection after endovascular aortic repair: the utility of 18F-FDG PET/CT in an infrequent but serious clinical setting

Zogala, David; Ručka, David; Ptáčník, Václav; Černý, Vladimír; Trnka, Jiří; Vařejka, P; Heller, Samuel; Lambert, Lukáš

doi:10.1007/s12149-019-01370-9

Cited by 13 publications

(13 citation statements)

References 19 publications

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“…Only two studies investigated the TBR, and therefore we could not perform a meta-analysis of this category. 23,24 As a reference standard, microbiologic assessment was used for VGEI in all of the studies. Clinical follow-up was used in more than half of the studies and ranged from 4 to 36 months.…”

Section: Study Characteristicsmentioning

confidence: 99%

A systematic review and meta-analysis of 18F-fluoro-d-deoxyglucose positron emission tomography interpretation methods in vascular graft and endograft infection

Folmer¹,

Meijenfeldt²,

Scholten

et al. 2020

Journal of Vascular Surgery

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Objective: Vascular graft and endograft infection (VGEI) has high morbidity and mortality rates. Diagnosis is complicated because symptoms vary and can be nonspecific. A meta-analysis identified 18 F-fluoro-D-deoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET/CT) as the most valuable tool for diagnosis of VGEI and favorable to computed tomography as the current standard. However, the availability and varied use of several interpretation methods, without consensus on which interpretation method is best, complicate clinical use. The aim of this study was to evaluate the diagnostic performance of different interpretation methods of 18 F-FDG PET/CT in diagnosis of VGEI.Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources included PubMed/MEDLINE, Embase, and Cochrane Library. A meta-analysis was conducted on the different interpretation methods for 18 F-FDG PET/CT in diagnosis of VGEI, including visual FDG uptake intensity, visual FDG uptake pattern, and quantitative maximum standardized uptake (SUVmax).Results: Of 613 articles, 13 were included (10 prospective and 3 retrospective articles). The FDG uptake pattern method (I 2 ¼ 26.2%) showed negligible heterogeneity, whereas the FDG uptake intensity (I 2 ¼ 42.2%) and SUVmax (I 2 ¼ 42.1%) methods showed moderate heterogeneity.The pooled sensitivity for FDG uptake intensity was 0.90 (95% confidence interval [CI], 0.79-0.96); for uptake pattern, 0.94 (95% CI, 0.89-0.97); and for SUVmax, 0.95 (95% CI, 0.76-0.99). The pooled specificity for FDG uptake intensity was 0.59 (95% CI, 0.38-0.78); for FDG uptake pattern, 0.81 (95% CI, 0.71-0.88); and for SUVmax, 0.77 (95% CI, 0.63-0.87).The uptake pattern interpretation method demonstrated the best positive and negative post-test probability, 82% and 10%, respectively.Conclusions: This meta-analysis identified the FDG uptake pattern as the most accurate assessment method of 18 F-FDG PET/CT for diagnosis of VGEI. The optimal SUVmax cutoff, depending on the vendor, demonstrated strong sensitivity and moderate specificity.

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Section: Study Characteristicsmentioning

confidence: 99%

A systematic review and meta-analysis of 18F-fluoro-d-deoxyglucose positron emission tomography interpretation methods in vascular graft and endograft infection

Folmer¹,

Meijenfeldt²,

Scholten

et al. 2020

Journal of Vascular Surgery

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“…Semi-quantitative analysis : several authors explored the possible role of SUV max or target-to-background ratio (T/B), normalizing the uptake for background activity in the liver or blood pool (usually in the cava vein) [ 86 ]. However, no definitive cut-off able to discriminate between an infection and sterile inflammation has been identified yet.…”

Section: Resultsmentioning

confidence: 99%

State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation

Casali

Lauri

Altini

et al. 2021

Clin Transl Imaging

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Aim The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([ 18 F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [ 18 F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. Methods In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [ 18 F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [ 18 F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. Results Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and

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“…In this case, the results of culture tests showed persistent and recurrent infections, and elevated MICs of P. aeruginosa against ceftazidime (2.0-8.0). In cases of postoperative mediastinitis, P. aeruginosa was the least common etiological agent (5.8%) (28). P. aeruginosa forms antibioticresistant biofilms on a wide range of substrates relevant to human infection (29).…”

Section: Discussionmentioning

confidence: 99%

Case Report: 18F-FDG PET-CT for Diagnosing Prosthetic Device-Related Infection in an Infant With CHD

et al. 2021

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Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of developing prosthetic device-related infection and mediastinitis. However, accurate diagnosis of prosthetic device-related infection can be difficult to evaluate and treat with antibiotic therapy alone. In recent years, 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) has made promising contributions to detect infective endocarditis, pacemaker infections, or other inflammations. Nevertheless, 18F-FDG PET-CT for congenital heart disease (CHD) with device infection has been sparsely reported. We present an infantile girl diagnosed with pulmonary atresia with a ventricular septal defect who underwent replacement of the right ventricle-to-pulmonary artery (RV-PA) conduit for improvement cyanosis. She developed high fever and was diagnosed with mediastinitis and bacteremia by Pseudomonas aeruginosa (P. aeruginosa) on postoperative day 4. Mediastinal drainage and 6 weeks of antibiotic therapy improved her condition, but bacteremia flared up on postoperative day 56. Despite a long course of antibiotic therapy, she had two more recurrences of bacteremia with the detection of P. aeruginosa. Echocardiography and chest contrast CT showed no evidence of vegetation and mediastinitis. On postoperative day 115, 18F-FDG PET-CT revealed an accumulation on the RV-PA conduit (SUV max 3.4). Finally, she developed an infectious ventricular pseudo-aneurysm on postoperative day 129 and underwent aneurysm removal and RV-PA conduit replacement on postoperative day 136. Our case showed the importance of 18F-FDG PET-CT for diagnosing specific localization of prosthetic device-related infection which is hard to detect using other imaging techniques. It can be a useful diagnostic tool for infantile patients with CHD with cardiac prosthetic devices and improve subsequent clinical treatments.

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How to recognize stent graft infection after endovascular aortic repair: the utility of 18F-FDG PET/CT in an infrequent but serious clinical setting

Cited by 13 publications

References 19 publications

A systematic review and meta-analysis of 18F-fluoro-d-deoxyglucose positron emission tomography interpretation methods in vascular graft and endograft infection

A systematic review and meta-analysis of 18F-fluoro-d-deoxyglucose positron emission tomography interpretation methods in vascular graft and endograft infection

State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation

Case Report: 18F-FDG PET-CT for Diagnosing Prosthetic Device-Related Infection in an Infant With CHD

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