Imaging Modalities for the Diagnosis of Vascular Graft Infections: A Consensus Paper amongst Different Specialists

Abstract

Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients.

State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation

“…Several imaging modalities are currently used for diagnosis and follow-up of VGI [ 65 ]. From a radiologic point of view, CT and computed tomography angiography (CTA) represent the gold standard imaging modalities for their ability to provide an anatomical overview of vascular tree and to detect suggestive signs for infection (peri-graft gas or fluid collection, fistulae, adjacent soft tissue abscesses).…”

“…Nevertheless, well-standardized acquisition protocols and interpretation criteria still do not exist in the specific field of VGI [27]. From several metaanalysis and systematic reviews emerges a high sensitivity but a low specificity for this modality [65,[68][69][70], mainly related to the high rate of false positives results that may be observed in presence of physiological post-surgical inflammation due to foreign body reaction induced by synthetic materials [71,72]. In one of the most recently published systematic reviews and meta-analysis, [69] the reported pooled sensitivity is 96%, ranging from 81% [73] and 100% [72,[74][75][76], whereas the reported pool specificity is 74%, ranging between 29% [77] and 92% [78].…”

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM

“…For CTA analysis and interpretation, see Tables 2 and 4. In doubtful cases, WBC-SPECT can further help define the presence/absence of infection at the vascular graft (76).…”

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation- (4Is) related cardiovascular diseases: a joint collaboration of the EACVI and the EANM: summary

“…In doubtful cases, WBC-SPECT can further help define the presence/absence of infection at the vascular graft. 36 …”