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The role of FDG PET/CT in therapy control of aortic graft infection

  • Original Article
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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

18F-FDG PET/CT (PET/CT) is a useful tool for the diagnosis of aortic graft infection (AGI), but has rarely been used to influence therapeutic decisions during follow-up. We aimed to study the role of PET/CT in the long-term monitoring of patients.

Methods

Participants of the prospective Vascular Graft Infection Cohort Study (VASGRA) were included if they had microbiologically proven AGI. We quantified the metabolic activity in PET/CT by using maximum standardized uptake value (SUVmax) and further classified it as being focal or diffuse. Multivariable linear regression models were fit using generalized estimating equations to investigate factors associated with SUVmax over time.

Results

Sixty-eight participants with AGI contributed to 266 PET/CTs including 36 examinations performed after stop of antimicrobial therapy. Higher C-reactive protein (CRP) (adjusted coefficient per log10 mg/L 0.05 [95% C.I. 0.02–0.08]) was associated with higher SUVmax. CRP, metabolic and clinical findings informed the decision to either start (medians of SUVmax 7.1 and CRP 31.5 mg/L; 100% focal uptake), escalate (SUVmax 9.5; CRP 31.5; 100% focal uptake), continue (SUVmax 6.0; CRP 9.95 mg/L; 90% focal uptake), or stop (SUVmax 4.3; CRP 3.5 mg/L; 61% focal uptake) antibiotic treatment. Of note, decisions to escalate or continue antibiotic treatment were taken despite normal CRP values in 12.5 and 35.7% of PET/CTs, respectively.

Conclusions

Consecutive PET/CTs could influence the clinical decision-making in patients with AGI in the near future. More studies on the use of PET/CT in case of aortic graft infection may offer the potential for individualized treatment approaches.

CLINICALTRIALS.GOV IDENTIFIER

NCT01821664.

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Acknowledgements

We are grateful to our patients for their commitment and thank B. Ruehe, C. Rüegg, A. Wolfensberger, U. Matt, M. Kälin and M. Greiner for excellent patient care. We also thank C. Müller and S. Bürgin, study nurses and C. Vögtli for administrative assistance.

The members of the VASGRA Cohort Study are (in alphabetical order): A. Anagnosto-poulos, B. Hasse (Principle investigator), L. Husmann, B. Ledergerber, M. Lachat, D. Mayer, Z. Rancic, A. Scherrer, A. Weber, R. Weber, R. Zbinden, A. Zinkernagel.

Funding

This study was financed within the framework of the Vascular Graft Cohort Study (VASGRA), supported by the Swiss National Science Foundation (SNF) grant #32473B_163132/1, a SNF protected-research-time for clinicans grant #32473B_163132/2; the Vontobel Foundation and the Rozalia Foundation (all to BH). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Clinic for Nuclear Medicine, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland

    Lars Husmann, Paul Stolzmann, Bert-Ram Sah & Irene A. Burger

  2. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Bruno Ledergerber, Alexia Anagnostopoulos, Roxana Pop & Barbara Hasse

  3. Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland

    Bert-Ram Sah

  4. Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Alberto Weber, Dieter Mayer & Zoran Rancic

  5. Department of Surgery, HFR Fribourg – Cantonal Hospital, Fribourg, Switzerland

    Dieter Mayer

Authors
  1. Lars Husmann
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  3. Alexia Anagnostopoulos
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  4. Paul Stolzmann
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  5. Bert-Ram Sah
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  6. Irene A. Burger
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  7. Roxana Pop
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  8. Alberto Weber
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  9. Dieter Mayer
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  10. Zoran Rancic
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  11. Barbara Hasse
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Consortia

the VASGRA Cohort Study

  • A. Anagnosto-poulos
  • , B. Hasse
  • , L. Husmann
  • , B. Ledergerber
  • , M. Lachat
  • , D. Mayer
  • , Z. Rancic
  • , A. Scherrer
  • , A. Weber
  • , R. Weber
  • , R. Zbinden
  •  & A. Zinkernagel

Contributions

BH and LH designed the study. BL analyzed the data. LH and BH wrote the first draft, and LH, BL, AA and BH wrote the final version of the manuscript. All investigators contributed to collection and interpretation of the data, reviewed drafts of the manuscript, and approved the final manuscript.

Corresponding author

Correspondence to Lars Husmann.

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Conflict of Interest

All authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board approved the study, and we obtained written informed consent from all participants (KEK-ZH-Nr. 2012–0583).

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Husmann, L., Ledergerber, B., Anagnostopoulos, A. et al. The role of FDG PET/CT in therapy control of aortic graft infection. Eur J Nucl Med Mol Imaging 45, 1987–1997 (2018). https://doi.org/10.1007/s00259-018-4069-1

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  • DOI: https://doi.org/10.1007/s00259-018-4069-1

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