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Low baseline and subsequent higher aortic abdominal aneurysm FDG uptake are associated with poor sac shrinkage post endovascular repair

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The growth phases of medically treated abdominal aortic aneurysms (AAA) are frequently associated with an 18F–fluorodesoxyglucose positron emission tomography (FDG-PET) pattern involving low baseline and subsequent higher FDG uptake. However, the FDG-PET patterns associated with the endovascular aneurysm repair (EVAR) of larger AAA are presently unknown. This study aimed to investigate the relationship between serial AAA FDG uptake measurements, obtained before EVAR and 1 and 6 months post-intervention and subsequent sac shrinkage at 6 months, a well-recognized indicator of successful repair.

Methods

Thirty-three AAA patients referred for EVAR (maximal diameter: 55.4 ± 6.0 mm, total volume: 205.7 ± 63.0 mL) underwent FDG-PET/computed tomography (CT) before EVAR and at 1 and 6 months thereafter, with the monitoring of AAA volume and of a maximal standardized FDG uptake [SUVmax] averaged between the axial slices encompassing the AAA.

Results

Sac shrinkage was highly variable and could be stratified into three terciles: a first tercile in which shrinkage was absent or very limited (0–29 mL) and a third tercile with pronounced shrinkage (56–165 mL). SUVmax values were relatively low at baseline in the 1st tercile (SUVmax: 1.69 ± 0.33), but markedly increased at 6 months (2.42 ± 0.69, p = 0.02 vs. baseline). These SUV max values were by contrast much higher at baseline in the 3rd tercile (SUVmax: 2.53 ± 0.83 p = 0.009 vs. 1st tercile) and stable at 6 months (2.49 ± 0.80), while intermediate results were documented in the 2nd tercile. Lastly, the amount of sac shrinkage, expressed in absolute values or in percentages of baseline AAA volumes, was positively correlated with baseline SUVmax (p = 0.001 for both).

Conclusion

A low pre-EVAR FDG uptake and increased AAA FDG uptake at 6 months are associated with reduced sac shrinkage. This sequential FDG-PET pattern is similar to that already shown to accompany growth phases of medically treated AAA.

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Acknowledgments

The authors thank the networks FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) and Cardiovascular Inserm Clinical Investigation Centers-CIC (Nancy CIC-P, Hôpital Européen Georges Pompidou AP-HP, Paris CIC-P, Lille CIC, Nantes CIC, Rouen CIC, Bichat CIC). The authors also thank M. Pierre Pothier for the editing of the manuscript and Henri Boutley who participated to the quantitative analysis of the PET images.

Funding

The study was sponsored by Nancy CHRU and supported by a DGOS-Inserm “ANR Translationnelle”.

Author information

Author notes

  1. Raphael Coscas and Martin Rouer contributed equally to this work.

Authors and Affiliations

  1. CHRU-Nancy, Université de Lorraine, Nuclear Medecine & Nancyclotep Platform, Nancy, F-54000, France

    Pierre-Yves Marie & Véronique Roch

  2. INSERM, University of Lorraine, UMR 1116, F-54000, Nancy, France

    Pierre-Yves Marie & Patrick Rossignol

  3. CHRU-Nancy, Hôpitaux de BRABOIS, Service de Médecine Nucléaire, Allée du Morvan, 54500, Vandœuvre, France

    Pierre-Yves Marie

  4. Department of Vascular Surgery, CHU-Rouen, F-76000, Rouen, France

    Didier Plissonnier & Martin Rouer

  5. CHRU-Nancy, Université de Lorraine, Department of Radiology, Nancy, F-54000, France

    Stéphanie Bravetti & Damien Mandry

  6. Chirurgie Vasculaire, Hôpital Ambroise Paré, APHP, F-92100, Boulogne-Billancourt, France

    Raphael Coscas

  7. Department of Vascular Surgery, CHU-Lille, F-59000, Lille, France

    Stéphan Haulon

  8. INSERM, University of Lorraine, UMR 947, F-54000, Nancy, France

    Damien Mandry & Emilien Micard

  9. Department of Vascular Surgery, APHP, HEGP, F-75000, Paris, France

    Jean-Marc Alsac

  10. CHRU-Nancy, Université de Lorraine, Vascular Surgery, Nancy, F-54000, France

    Sergueï Malikov & Nicla Settembre

  11. Department of Vascular Surgery, CHU-Nantes, F-44000, Nantes, France

    Yann Gouëffic

  12. Department of Nuclear Medecine, CHU-Besançon, F-25000, Besançon, France

    Olivier Morel

  13. INSERM, CHRU-Nancy, Université de Lorraine, CIC-1433, FCRIN INI-CRCT, F-54000, Nancy, France

    Emilien Micard, Zohra Lamiral & Patrick Rossignol

  14. INSERM, Bichat, UMR 698, F-75000, Paris, France

    Jean-Baptiste Michel

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  1. Pierre-Yves Marie
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  2. Didier Plissonnier
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Corresponding author

Correspondence to Pierre-Yves Marie.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Marie, PY., Plissonnier, D., Bravetti, S. et al. Low baseline and subsequent higher aortic abdominal aneurysm FDG uptake are associated with poor sac shrinkage post endovascular repair. Eur J Nucl Med Mol Imaging 45, 549–557 (2018). https://doi.org/10.1007/s00259-017-3883-1

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  • DOI: https://doi.org/10.1007/s00259-017-3883-1

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