Detection of aortic prosthetic graft infection with 18F-FDG PET/CT imaging, concordance with consensus MAGIC graft infection criteria

Abstract

Objectives

The aim of this study was to investigate the diagnostic yield of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for detecting thoracic aortic graft infection (AGI) in comparison to expert consensus MAGIC criteria.

Methods

Patients suspected clinically of having thoracic-AGI were prospectively recruited. Consensus MAGIC criteria for AGI were compared to findings on FDG PET imaging. MAGIC criteria were verified against clinical/surgical, radiological, and microbiological/laboratory predefined major and minor parameters. FDG images were interpreted using a semiquantitative visual grading score (VGS, abnormal ≥ 3), focal uptake and quantitative maximum standard FDG uptake value (SUVmax, abnormal ≥ 7.3), and target-to-background FDG ratio (TBRmax, abnormal ≥ 4.2).

Results

Of 35 patients suspected of having thoracic-AGI, MAGIC diagnostic criteria were positive for AGI in 25 patients (71%) and negative in 10 (29%). FDG PET imaging was abnormal in 27 patients (77%). Abnormal and normal FDG imaging findings were concordant with MAGIC criteria in 31 patients (88.6%). In 4 patients, FDG imaging results were discordant with MAGIC criteria. By ROC analysis, optimal FDG cut-off values for detecting AGI by MAGIC were ≥ 3 for VGS, ≥ 7.3 for SUVmax and ≥ 4.2 for TBRmax, with concordance with MAGIC criteria in 88.6%, 85.7%, and 88.6% of patients, respectively. Two or more FDG imaging parameters (VGS, focal uptake, SUVmax, and TBRmax) yielded highest diagnostic concordance of 91.4%. VGS inverse odds ratio for AGI was 7.14. In 4 of 6 selective patients who had repeat FDG PET imaging during antibiotic treatment, quantitative FDG imaging values improved over time with associated improvement of laboratory markers of inflammation.

Conclusions

FDG PET/CT imaging, using (semi-)quantitative imaging parameters, showed high concordance with expert consensus MAGIC criteria for AGI. These data suggest a potential complementary role of quantitative FDG/CT imaging, not only to detect AGI, but also to monitor response to antibiotic treatment.

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Abbreviations

AGI:

Aortic graft infection

AUC:

Area under the curve

CT:

Computed tomography

18F-FDG:

18F-Fluorodeoxyglucose, FDG

PET:

Positron emission tomography

ROC:

Receiver operating characteristic

SUV:

Standardized uptake value

TBR:

Target-to-background ratio

VGS:

Visual grading score

VOI:

Volume of interest

WBC:

White blood cell count

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Acknowledgments

This article was finalized under the auspices of the ‘‘Mentorship at Distance’’ committee of the Journal of Nuclear Cardiology. We gratefully acknowledge the editorial suggestions by Professor Frans J. Th. Wackers, MD, PhD.

Disclosures

All authors have nothing to declare. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors declare that they have no conflict with competing interests.

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Correspondence to Xiaoli Zhang MD, PhD or Xiang Li MD, PhD.

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This work was supported by the National Natural Science Foundation of China [81871377, 81571717, 81071177] and Capital Characteristic Clinical Application Research [Z181100001718071].

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Dong, W., Li, Y., Zhu, J. et al. Detection of aortic prosthetic graft infection with 18F-FDG PET/CT imaging, concordance with consensus MAGIC graft infection criteria. J. Nucl. Cardiol. (2020). https://doi.org/10.1007/s12350-020-02227-9

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Keywords

  • PET/CT
  • 18F-FDG
  • diagnostic concordance
  • prosthetic vascular graft
  • infection
  • antibiotic