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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) PET/CT with 18F-Fluordesoxyglucose PET/CT in patients with suspected vascular pr...
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Vol. 40. Issue 1.
Pages 12-18 (January - February 2021)
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Vol. 40. Issue 1.
Pages 12-18 (January - February 2021)
Original Article
DOI: 10.1016/j.remnie.2020.09.018
PET/CT with 18F-Fluordesoxyglucose PET/CT in patients with suspected vascular prosthesis infection
PET/TC con 18F-Fluordesoxiglucosa en pacientes con sospecha de infección de prótesis endovasculares
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C. Vigil Díaz
Corresponding author
carmenvigildiaz@gmail.com

Corresponding author.
, C. Salvat Dávila, B. Fernández Llana, M.L. Domínguez Grande, J.P. Suárez Fernández, N. Martín Fernández, O.D. Rodríguez Fonseca, D. Lisei Coscia, F.M. González García
Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Table 1. Descriptive data of the series of patients.
Table 2. Summary of the statistical analyses of the qualitative and quantitative parameters of FDG-PET.
Table 3. Summary of the main series published on FDG-PET in vascular prosthesis infection.
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Abstract
Objective

Infection of large vessel prostheses is a rare but critical complication. The aim of this work is to assess the impact of PET/CT with 18F-Fluordesoxyglucose (PET-FDG) on the diagnosis of infection in our clinical setting.

Material and methods

Thirty-five patients (38 scans) were evaluated for suspected prosthetic infection. A qualitative analysis was performed taking into account the distribution of the radiopharmaceutical, categorizing the studies as positive or negative for infection. Those with focal or multifocal deposits along the vascular prosthesis were considered positive, and negative if a homogeneous and diffuse distribution over the whole prosthesis was observed, or a total absence of uptake. A semi-quantitative analysis was performed using SUVmax and average SUV values, and a metabolic index was calculated (SUVmax of the graft / SUV SUV mean of the normal vascular pool). Diagnostic performance was compared with conventional angiographic imaging techniques (AngioTC).

Results

The PET-FDG study was positive in 20 patients, with a diagnostic accuracy of 84%. The 38 PET-FDG scans performed showed positive capture patterns (focal in 6, multifocal in 15, diffuse in 4) and negative pattern in the remaining 13. The sensitivity, specificity, positive and negative predictive values obtained for the PET-FDG were 95%, 89%, 90% and 94%, and for the AngioTC study 50%, 73%, 73% and 50%, respectively. The area values under the ROC curve were as follows: for the AngioTC 0.642 (not significant), and for the SUVmax values of 0.925 (p < 0.005), average SUV of 0.922 (p < 0.005) and for the metabolic index of 0.917 (p < 0.005).

Conclusions

The PET-FDG proves to be a tool with high diagnostic accuracy in the infection of vascular prosthesis, both visual analysis according to patterns and semi-quantitative.

Keywords:
PET/CT
18F-Fluordesoxyglucose
Vascular prosthesis
Vascular grafts
infection
Resumen
Objetivo

La infección de prótesis vasculares de grandes vasos es una complicación poco frecuente pero crítica. El objetivo de este trabajo es valorar el impacto del PET/TC con 18F-Fluordesoxiglucosa (PET-FDG) en el diagnóstico de infección en nuestro entorno.

Material y métodos

Se evaluaron 35 pacientes (38 exploraciones) por sospecha de infección protésica. Se realizó un análisis cualitativo teniendo en cuenta la distribución del radiofármaco, categorizando los estudios como positivos o negativos para infección. Se consideraron positivos aquellos que presentaban depósitos focales o multifocales a lo largo de la prótesis vascular, y negativos si se observaba una distribución homogénea y difusa sobre la totalidad de la prótesis, o la ausencia total de captación. Se realizó un análisis semicuantitativo empleando los valores SUVmax y SUVmedio, y se calculó un índice metabólico (SUVmax del injerto / SUVmedio del pool vascular normal). Se comparó el rendimiento diagnóstico con las técnicas de imagen convencional angiográfica (AngioTC).

Resultados

El estudio PET-FDG fue positivo en 20 pacientes, con una precisión diagnóstica del 84%. Las 38 exploraciones PET-FDG realizadas mostraron patrones de captación positivos (focal en 6, multifocal en 15, difuso en 4) y patrón negativo en los 13 restantes. Los valores de sensibilidad, especificidad, valor predictivo positivo y negativo obtenidos para el PET-FDG fueron de 95%, 89%, 90% y 94%, y para el estudio AngioTC de 50%, 73%, 73% y 50%, respectivamente. Los valores del área bajo la curva ROC fueron los siguientes: para el AngioTC 0,642 (no significativo), y para los valores del SUVmax de 0,925 (p < 0,005), SUVmedio de 0,922 (p < 0,005) y para el índice metabólico de 0,917 (p < 0,005).

Conclusiones

El PET-FDG demuestra ser una herramienta con una elevada precisión diagnóstica en la infección de prótesis vasculares, tanto el análisis visual según patrones como el semicuantitativo.

Palabras clave:
PET/TC
18F-Fluordesoxiglucosa
Prótesis vasculares
Injertos vasculares
Infección

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