Clinical and Translational Imaging

, Volume 7, Issue 4, pp 255–265 | Cite as

FDG-PET/CT as a diagnostic tool in vascular graft infection: a systematic review and meta-analysis

  • Synnøve Klyve Sunde
  • Therese Beske
  • Oke Gerke
  • Lene Langhoff Clausen
  • Søren HessEmail author
Part of the following topical collections:
  1. Infection and inflammation



Vascular graft infection (VGI) in central grafts is a rare but dreaded complication with a high mortality. Several imaging modalities are employed, all with pros and cons. Computed tomography is the standard, but lacks sensitivity for low-grade infections. There is still no consensus regarding the diagnostic modality of choice. The study objective was to assess the role of combined positron emission tomography and computed tomography with fluorodeoxyglucose (FDG-PET/CT) in the diagnostic workup of VGI in central grafts.


A systematic review was conducted according to the PRISMA guidelines through a search in Embase, PubMed, and Cochrane databases. Meta-analysis on accuracy measures was carried out with random effects models for three parameters: focal uptake, visual grading scale (VGS), and maximum standardized uptake value (SUVmax). Heterogeneity among studies was assessed with the I-squared test.


A total of 307 studies were identified and 9 were eligible for inclusion. The pooled estimates for sensitivity and specificity for focal uptake were 90.6% (95% CI 81.7–99.4%) and 82.8% (95% CI 71.3–94.3%), respectively, for VGS 86.8% (95% CI 59.3–100%) and 69.4% (95% CI 39.9–98.9%), respectively, for SUVmax 92.8% (95% CI 83.2–100%) and 69.7% (95% CI 52.4–86.9%), respectively. A single study employed tissue-to-background ratio (TBR) and found sensitivity and specificity of 71.8% (95% CI 54.6–84.4%) and 70.4% (95% CI 51.5–84.2%), respectively.


According to this systematic review and meta-analysis, FDG-PET/CT performs well especially when using focal versus diffuse FDG uptake to diagnose VGI.


Vascular graft Infections Positron emission tomography PET Computed tomography CT 



The authors would like to thank specialist research librarian Herdis Foverskov (University Library of Southern Denmark) for the help with developing the search strategy.

Author contributions

SKS: literature search, literature review, meta-analysis, writing, editing, content planning; TB: literature search, literature review, meta-analysis, writing, editing, content planning; OG: literature review, meta-analysis, writing, editing, content planning; LLC: literature review, writing, editing, content planning; SH: literature review writing, editing, content planning.


There are no financial disclosures; this work received no funding.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

40336_2019_336_MOESM1_ESM.pdf (154 kb)
Supplementary material 1 PRISMA checklist. Adapted from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. (PDF 154 kb)
40336_2019_336_MOESM2_ESM.pdf (969 kb)
Supplementary material 2 Funnel plots (PDF 968 kb)
40336_2019_336_MOESM3_ESM.tif (1.8 mb)
Supplementary material 3 SROC-curve for focal uptake (TIFF 1886 kb)
40336_2019_336_MOESM4_ESM.docx (17 kb)
Supplementary material 4 (DOCX 17 kb)
40336_2019_336_MOESM5_ESM.docx (14 kb)
Supplementary material 5 (DOCX 13 kb)


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Copyright information

© Italian Association of Nuclear Medicine and Molecular Imaging 2019

Authors and Affiliations

  1. 1.Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
  2. 2.Department of Nuclear MedicineOdense University HospitalOdenseDenmark
  3. 3.Department of Cardiothoracic and Vascular SurgeryOdense University HospitalOdenseDenmark
  4. 4.Department of Radiology and Nuclear MedicineHospital of Southwest JutlandEsbjergDenmark
  5. 5.Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark

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