Prosthetic Vascular Graft Infection: The Role of ¹⁸F-FDG PET/CT

¹ Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
² B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Radiology, Rambam Health Care Campus, Haifa, Israel
³ B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Vascular Surgery, Rambam Health Care Campus, Haifa, Israel

^* To whom correspondence should be addressed. E-mail: zohar{at}keidar.net.

	Abstract

Graft infection after prosthetic vascular reconstruction is an uncommon but severe complication. The clinical presentation is often subtle and nonspecific and may occur long after surgery. Although defining a prosthetic vascular graft infection can be difficult, early diagnosis and treatment are important because of the relatively high rates of amputation and death. The present study assessed the role of PET/CT using ¹⁸F-FDG for the diagnosis of vascular graft infections. Methods: Thirty-nine patients (35 men and 4 women; age range, 44-82 y) with suspected vascular graft infection underwent ¹⁸F-FDG PET/CT. The performance of PET/CT for the diagnosis of an infectious process and its localization to the graft or soft tissues was assessed. The final diagnosis was based on histopathologic findings and microbiologic assays obtained at surgery or on clinical and imaging follow-up. Results: PET/CT detected foci of increased ¹⁸F-FDG uptake suspected as infection in 27 patients and localized these findings to the graft in 16 patients. Vascular graft infection was confirmed in 14 of these patients (88%). PET/CT excluded graft involvement in 11 patients, and in 10 (91%) of these 11, long-term follow-up further confirmed that the infectious process was limited to surrounding soft tissues only. No abnormal ¹⁸F-FDG uptake was found in any of the 12 patients with no further evidence of infection. PET/CT had a sensitivity of 93%, specificity of 91%, positive predictive value of 88%, and negative predictive value of 96% for the diagnosis of vascular graft infection. Conclusion: ¹⁸F-FDG PET/CT is a reliable noninvasive imaging modality for the diagnosis of vascular graft-related infection. The precise anatomic localization of increased ¹⁸F-FDG uptake provided by PET/CT enables accurate differentiation between graft and soft-tissue infection.

Key Words: PET/CT, infection, prosthetic vascular graft

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