Comparing diagnostic accuracy of 18F-FDG-PET/CT, contrast enhanced CT and combined imaging in patients with suspected vascular graft infections

Background To evaluate the diagnostic accuracy of positron emission tomography/computed tomography with 18 F-fluorodeoxyglucose (PET/CT), contrast-enhanced CT (CE-CT), and a combined imaging approach (CE-PET/CT) in patients with suspected vascular graft infection (VGI). Methods PET/CT and CE-CT were...

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Published in:European journal of nuclear medicine and molecular imaging 2019-06, Vol.46 (6), p.1359-1368
Main Authors: Husmann, Lars, Huellner, Martin W., Ledergerber, Bruno, Anagnostopoulos, Alexia, Stolzmann, Paul, Sah, Bert-Ram, Burger, Irene A., Rancic, Zoran, Hasse, Barbara
Format: Article
Language:English
Subjects:
Accuracy
Biopsy
Cardiology
Clinical decision making
Clinical trials
Computed tomography
Decision making
Diagnosis
Diagnostic systems
Emission analysis
Evaluation
Fluorine isotopes
Grafting
Imaging
Infections
Medical diagnosis
Medical imaging
Medical research
Medicine
Medicine & Public Health
Microbiological culture
Nuclear Medicine
Oncology
Original Article
Orthopedics
Patients
Positron emission
Positron emission tomography
Radiology
Sensitivity
Tomography
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Summary:Background To evaluate the diagnostic accuracy of positron emission tomography/computed tomography with 18 F-fluorodeoxyglucose (PET/CT), contrast-enhanced CT (CE-CT), and a combined imaging approach (CE-PET/CT) in patients with suspected vascular graft infection (VGI). Methods PET/CT and CE-CT were performed prospectively in 23 patients with suspected VGI. Diagnostic accuracy for PET/CT was assessed by using previously suggested cut-off points for maximum standardized uptake values (SUV max ) measured in the vicinity of the graft. Using a new 4-point scale for visual grading, two readers independently assessed the diagnostic accuracy for CE-CT and combined CE-PET/CT. Microbiological culture, obtained after open biopsy or graft explantation, and clinical follow-up of the patients served as the standard of reference. Results Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of PET/CT for the diagnosis of VGI was 100%, 50%, 100%, 72.2%, and 78.3%, using the most favorable SUV max cut-off ≥ 4.9. Respective values for CE-CT were 100%, 50%, 100%, 72.2%, and 78.3% for reader 1, and 92.3%, 80%, 88.9%, 85.7%, and 86.9% for reader 2; while respective values for combined CE-PET/CT were 100%, 70%, 100%, 81.3%, and 86.9% for reader 1, and 100%, 80%, 100%, 86.7%, and 91.3% for reader 2. Additionally, imaging provided a conclusive clinical diagnosis in patients without graft infection (i.e., other sites of infection): five of ten patients with CE-CT, six of ten patients with PET/CT, and seven of ten patients with combined CE-PET/CT. Conclusion The diagnostic accuracy of combined CE-PET/CT in patients with suspected VGI is very high. The combination of the high sensitivity of PET/CT in detecting metabolically active foci in infection, and the high specificity of CE-CT in detecting anatomic alterations, appears to be the reason why combined imaging outperforms stand-alone imaging in diagnosing VGI and may be supportive in future decision-making of difficult cases of suspected VGI. Clinical Trials.gov Identifier : NCT01821664.
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-018-4205-y