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High ¹⁸F-FDG Uptake in Synthetic Aortic Vascular Grafts on PET/CT in Symptomatic and Asymptomatic Patients

¹ Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden; ² Department of Radiology, Karolinska University Hospital, Stockholm, Sweden; ³ Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; ⁴ Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, Sweden; and ⁵ Department of Hospital Physics, Karolinska University Hospital, Stockholm, Sweden

View larger version (98K): [in this window] [in a new window]   FIGURE 1.  CT, PET, and merged PET/CT images in transaxial plane and merged PET/CT images in coronal plane. Top 2 rows illustrate patients who underwent conventional open surgery, and bottom 2 rows illustrate patients operated with EVAR. Normal 18F-FDG accumulation in kidneys (K), ureters (u), liver (L), and bowel segments (B) is indicated in images. Patient 9 illustrates typical appearance of majority of conventional synthetic aortic grafts in material (arrows), with high 18F-FDG accumulation in virtually entire length of graft (SUVmax = 4.4; TBR = 3.4). Marked difference between normal vessel wall and graft is seen at site of proximal anastomosis (arrowhead). Patient 7 illustrates that few patients had low levels of 18F-FDG accumulation in their grafts (SUVmax = 2.8; TBR = 2.0). Patient 13 illustrates the only case of EVAR graft with high 18F-FDG accumulation (SUVmax = 5.4; TBR = 2.8), whereas patient 15 exemplifies low 18F-FDG accumulation seen at the grafts in the other EVAR patients (SUVmax = 2.4; TBR = 1.3).

View larger version (27K): [in this window] [in a new window]   FIGURE 2.  Patient 14 referred for suspected graft infection after presenting with fever 7 mo after EVAR. CT, PET, and merged PET/CT images in transaxial plane and merged PET/CT images in coronal plane illustrate high 18F-FDG accumulation around aneurysmal sac. Results were interpreted as aseptic postoperative inflammation, and patient made full recovery without antibiotic treatment. Normal 18F-FDG accumulation in kidneys (K) and bowel segments (B) is indicated in images.

View larger version (72K): [in this window] [in a new window]   FIGURE 3.  Patient 12, who was referred for suspected graft infection after presenting with fever of unknown origin 5 y after uneventful open surgery and postoperative recovery. Shown are CT, PET, and merged PET/CT images in transaxial plane and merged PET/CT images in coronal plane (top row) and sagittal plane (middle row) and leukocyte scintigraphy in region of aortic graft (bottom row). Normal 18F-FDG accumulation in kidneys (K) and bowel segments (B) is indicated in images. Top row and coronal and sagittal planes illustrate 18F-FDG accumulation (arrows) in area close to proximal anastomosis, which was assessed as noninfected. Middle row illustrates 18F-FDG accumulation close to bifurcation corresponding to soft-tissue mass seen on CT ventral to graft (arrowheads) (not well illustrated on coronal projection [top row on far right] but well illustrated on sagittal projection [middle row on far right]). Bottom row illustrates results of leukocyte scintigraphy, with distinct uptake corresponding to area of graft bifurcation (arrows).