Research ArticleCLINICAL INVESTIGATIONS

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

Johan Wassélius, Jonas Malmstedt, Bo Kalin, Stig Larsson, Anders Sundin, Ulf Hedin and Hans Jacobsson
Journal of Nuclear Medicine October 2008, 49 (10) 1601-1605; DOI: https://doi.org/10.2967/jnumed.108.053462

Article Figures & Data

Figures

  • FIGURE 1. 
    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).

  • FIGURE 2. 
    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.

  • FIGURE 3. 
    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).

Tables

  • TABLE 1

    Clinical Characteristics of Patients

    Patient no.Age (y)SexYears after surgerySurgeryPostoperative eventsCRP (mg/L)WBC (×109/L)
    183M13.0OpenNone68.3
    277M5.7OpenNone1012.2
    375M20.0OpenNone129.1
    475F8.1OpenNone45.8
    574M6.7OpenNone346.5
    674M1.3OpenNone3414.2
    774M3.4OpenNone37.5
    873M5.4OpenNone726.8
    970M7.8OpenNone1911.6
    1067M1.7OpenNone251.2
    1162M11.2OpenNone75.5
    1264M5.0OpenNone429.0
    1381M1.7EVARNone117.2
    1481M0.8EVARInflamed aneurysmal sac68.9
    1572M1.6EVARNone14.2
    1670M0.1EVARNone925.4

    • CRP and WBC were analyzed before PET/CT examination. Reference values were <10 mg/L for CRP and 3.5–8.8 × 109/L for WBC.

  • TABLE 2

    Data from PET/CT Examinations

    Patient no.Reason for PET/CT referralRadiologic diagnosisAntibioticsBlood-pool SUVmeanGraft SUVmaxTBR
    1Lung cancerLung cancerNo1.33.72.8
    2Lung cancerLung cancerNo1.25.24.3
    3Any infectionNormalNo2.26.02.7
    4Vaginal cancerNormalNo1.14.13.7
    5AortitisThyroiditisNo2.02.81.4
    6TumorColon cancerNo1.54.02.7
    7ResearchNormalNo1,42,82,0
    8Graft infectionPneumoniaYes*1.84.22.3
    9Lung cancerLung cancerNo1.34.43.4
    10TumorThymomaNo2.34.92.1
    11Lung cancerLung cancerNo2.66.52.5
    12Graft infectionGraft infectionYes†1.48.05.7
    13Lung cancerLung cancerNo1.95.42.8
    14Graft infectionInflamed aneurysmal sacNo1.31.71.3
    15Lung cancerLung cancerNo1.92.41.3
    16ResearchNormalNo1.01.81.8

    • ↵* Patient 8 was prescribed oral sulfametoxazol/trimetoprim (Bactrim; F. Hoffmann-La Roche Ltd.) and metronidazol (Flagyl; Sanofi-aventis).

    • ↵† Patient 12 was administered intravenously piperacillin and tazobaktam (Tazocin; WyethFive Giralda Farms).

    • TBR = SUVmax/blood-pool SUVmean.

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