Diagnostic Imaging in Vascular Graft Infection: A Systematic Review and Meta-Analysis

Abstract

This meta-analysis suggests the diagnostic performance of WBC scintigraphy combined with SPECT/CT is the greatest in diagnosing VGI. However, it is a time consuming technique and not always available. Therefore FDG-PET/CT may be favourable as the initial imaging technique. The use of solitary CTA in diagnosing VGI seems to be obsolete.

Diagnostic performance and image interpretation of 18F-FDG PET/CT in aortic graft infection: Two sides of the same coin

“…6 Recent evidence-based articles have demonstrated the overall good diagnostic performance of 18 F-FDG PET or PET/CT for the diagnosis of vascular graft infection, including AGI (Table 1). [7][8][9] All the published meta-analyses are concordant about the high sensitivity and reasonable specificity of 18 F-FDG PET or PET/CT in this setting, independently from the different image analysis (qualitative or quantitative) used for the diagnosis, but false positive and false negative results should be taken into account. [7][8][9] In particular, reactive 18 F-FDG uptake in inflammatory cells around the vascular graft can mimic infection and it is a well-known confounder of 18 F-FDG PET image interpretation, in particular in cases of recent surgery.…”

“…[7][8][9] All the published meta-analyses are concordant about the high sensitivity and reasonable specificity of 18 F-FDG PET or PET/CT in this setting, independently from the different image analysis (qualitative or quantitative) used for the diagnosis, but false positive and false negative results should be taken into account. [7][8][9] In particular, reactive 18 F-FDG uptake in inflammatory cells around the vascular graft can mimic infection and it is a well-known confounder of 18 F-FDG PET image interpretation, in particular in cases of recent surgery. [7][8][9] Interestingly, it has been demonstrated that the combination of 18 F-FDG PET/CT reduces the false positive and false negative results compared to 18 F-FDG PET only.…”

“…[7][8][9] In particular, reactive 18 F-FDG uptake in inflammatory cells around the vascular graft can mimic infection and it is a well-known confounder of 18 F-FDG PET image interpretation, in particular in cases of recent surgery. [7][8][9] Interestingly, it has been demonstrated that the combination of 18 F-FDG PET/CT reduces the false positive and false negative results compared to 18 F-FDG PET only. 9 The evidence-based articles available so far suggested that the diagnostic performance of 18 F-FDG PET/CT for vascular graft infection should be examined in aortic and peripheral grafts separately, since it may vary significantly according to the graft location.…”

“…[7][8][9] Interestingly, it has been demonstrated that the combination of 18 F-FDG PET/CT reduces the false positive and false negative results compared to 18 F-FDG PET only. 9 The evidence-based articles available so far suggested that the diagnostic performance of 18 F-FDG PET/CT for vascular graft infection should be examined in aortic and peripheral grafts separately, since it may vary significantly according to the graft location. [7][8][9] To date, even if we have increasing evidence-based data about the diagnostic performance of 18 F-FDG PET/ CT in AGI, a major concern remains the lack of standardized and evidence-based interpretation criteria of 18 F-FDG PET/CT images as there is a remarkable variability in the parameters used among the published studies to analyze the 18 F-FDG PET images.…”

“…9 The evidence-based articles available so far suggested that the diagnostic performance of 18 F-FDG PET/CT for vascular graft infection should be examined in aortic and peripheral grafts separately, since it may vary significantly according to the graft location. [7][8][9] To date, even if we have increasing evidence-based data about the diagnostic performance of 18 F-FDG PET/ CT in AGI, a major concern remains the lack of standardized and evidence-based interpretation criteria of 18 F-FDG PET/CT images as there is a remarkable variability in the parameters used among the published studies to analyze the 18 F-FDG PET images. [7][8][9] The most commonly used parameters for 18 F-FDG PET/CT image interpretation include the pattern of 18 F-FDG uptake (focal/diffuse), the visual grading scale (VGS), the maximal standardized uptake value (SUV max ), the tissue to background ratio (TBR), or a combination of them.…”