Usefulness of 18 F-FDG-PET/CT in aortic graft infection: two cases

Abstract

Diagnosis of vascular graft prosthesis infection is crucial, but not straightforward. Here we report two cases in which [18 F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18 F-FDG PET/CT) was very useful in the diagnosis of aortic graft infection. Case 1: A 77-year-old Japanese man, two months status post aortic arch graft surgery, suffered from repeated fevers. Blood cultures revealed bacteremia. 18 F-FDG-PET/CT ruled out graft infection and diagnosed lumbar pyogenic spondylitis, which was treated with antibiotics, sparing the patient a possible reoperation. Case 2: A 53-year-old Japanese man, seven years status post replacement of the aortic root and ascending aorta, had been suffering from an ostensibly aseptic fistula for over a year and a half. Although repeated CT findings had been negative, 18 F-FDG-PET/CT clearly demonstrated communication between the fistula and the ascending aortic graft. He was treated with repeat ascending aortic replacement, omentopexy, and antibiotics. Our experience supports 18 F-FDG-PET/CT as a promising modality in cases of suspected vascular graft infection.

Hybrid imaging of vascular graft infection by positron emission tomography with computed tomography using fluorine-18-labeled fluorodeoxyglucose: The Serbian National PET Center experience

“…The results of our study show high sensitivity (95%) and specificity (100%) of 18 F-FDG PET/CT in detection of vascular graft infection, similar to those in the paper of Keidar et al [18], who reported sensitivity of 93% and specificity of 91%, as well in other papers [19,20]. How-ever, specificity may vary, which can be explained by physiological uptake in postoperative inflammation, healing tissue or chronic inflammatory reactions induced by the graft [15,16,21]. 18 F-FDG PET/CT had better diagnostic performance than CT in this study, similar to the results of other studies [4,22].…”

“…In our study, 18 F-FDG PET/CT helped in treatment alteration of 63.2% of the patients, which is why it is considered to be a helpful tool in avoiding unnecessary surgery and it contributes to the optimal treatment [15,25].…”

“…In our study, 63.6% of findings were false negative on CT, in comparison to one false negative on 18 F-FDG PET/CT. This can be explained by the fact that both sensitivity and specificity of CT decrease in chronic infection [4,15].…”

Refractory Pyogenic Spondylitis Subsequent to Vascular Graft Infection: A Case Report

“…To the best of our knowledge, there have only been 67 cases reported in the English literature to date. [1][2][3] Early diagnosis and treatment of pyogenic spondylitis with vascular graft infection are important, but challenging, if the symptoms are subtle and non-specific. In our case, despite the early diagnosis of pyogenic spondylitis, the patient continued to have sepsis because of delayed recognition and treatment of his vascular graft infection.…”

Aortic prosthetic graft infection detected by 18F-fluorodeoxyglucose positron emission tomography/computed tomography

“…However, it is associated with high mortality; 46% patients died during a mean follow-up of 5 years because of complications [2]. Recently, the usefulness of 18 F-FDG PET/CT for detection of graft infection has been reported [3][4][5][6]. Although diffuse FDG uptake is frequently observed in noninfected vascular grafts [7], an SUVmax value N8 around the graft indicates a high probability of graft infection [4].…”