Abstract

Purpose

Aortic endograft infection (EI) can result in potentially life-threatening vascular complications. Unfortunately, it is difficult to obtain a correct diagnosis at an early stage in many patients. This report aims at validating the use of [¹⁸F] FDG PET/CT imaging for suspected endograft infections in a prospectively collected cohort of patients treated with EVAR and TEVAR.

Materials and methods

During a 14-year period, 366 patients required aortic stent graft. All procedures were performed electively, except for one patient. Among these 366 patients, eleven patients (3%) were suspected to have aortic EI. Contrast-enhanced CT and FDG PET/CT were performed in all 11 patients. Medical charts and imaging were analysed for these 11 cases, with initial positive CT.

Results

The final diagnosis of EI was established in seven (1,9%) based on clinical features, laboratory investigations and a significant [¹⁸F] FDG uptake in the aortic graft as well as the aortic wall. The median time from the initial EVAR/TEVAR to diagnosed infection was 180 days. During follow-up, the seven patients had a second PET/CT that was compared with the initial evaluation, decreased uptake was correlated with clinical improvement.

Conclusions

Contemporary diagnostic imaging for a potentially lethal endograft infection lacks precision, this observational study illustrates the potential clinical value of [¹⁸F] FDG PET/CT in the management of aortic EI. [¹⁸F] FDG PET/CT constitutes an imaging modality able to confirm the diagnosis, monitor disease progression as well as the effect of pharmaceutical treatment and detect relapse.

中文翻译：

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[18F] FDG PET/CT可提高主动脉移植物感染的诊断准确性

摘要

目的

主动脉内移植物感染 (EI) 可导致潜在的危及生命的血管并发症。不幸的是，许多患者很难在早期获得正确的诊断。本报告旨在验证在前瞻性收集的接受 EVAR 和 TEVAR 治疗的患者队列中，使用 [ ^{18 F] FDG PET/CT 成像对疑似内移植物感染进行治疗。}

材料和方法

在 14 年期间，366 名患者需要主动脉覆膜支架。除一名患者外，所有程序都是选择性进行的。在这 366 名患者中，有 11 名患者 (3%) 被怀疑患有主动脉 EI。对所有 11 名患者进行了增强 CT 和 FDG PET/CT。对这 11 例病例的病历和影像学进行了分析，初始 CT 呈阳性。

结果

根据临床特征、实验室检查和主动脉移植物和主动脉壁中显着的 [ ^{18 F] FDG 摄取，在 7 人 (1.9%) 中确定了 EI 的最终诊断。}从最初的 EVAR/TEVAR 到确诊感染的中位时间为 180 天。在随访期间，7 名患者进行了第二次 PET/CT，与初始评估相比，摄取减少与临床改善相关。

结论

当代对可能致命的内移植物感染的诊断成像缺乏精确度，这项观察性研究说明了 [ ¹⁸ F] FDG PET/CT 在主动脉 EI 管理中的潜在临床价值。[ ¹⁸ F] FDG PET/CT 是一种能够确认诊断、监测疾病进展以及药物治疗效果和检测复发的成像方式。