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

Authors :: Husmann L
Ledergerber B
Anagnostopoulos A
Stolzmann P
Sah BR
Burger IA
Pop R
Weber A
Mayer D
Rancic Z
Hasse B
Source :: European journal of nuclear medicine and molecular imaging [Eur J Nucl Med Mol Imaging] 2018 Oct; Vol. 45 (11), pp. 1987-1997. Date of Electronic Publication: 2018 Jun 11.
Publication Year :: 2018
Abstract: Purpose: <superscript>18</superscript> F-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.<br />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 (SUV <subscript>max</subscript> ) and further classified it as being focal or diffuse. Multivariable linear regression models were fit using generalized estimating equations to investigate factors associated with SUV <subscript>max</subscript> over time.<br />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 log <subscript>10</subscript> mg/L 0.05 [95% C.I. 0.02-0.08]) was associated with higher SUV <subscript>max</subscript> . CRP, metabolic and clinical findings informed the decision to either start (medians of SUV <subscript>max</subscript> 7.1 and CRP 31.5 mg/L; 100% focal uptake), escalate (SUV <subscript>max</subscript> 9.5; CRP 31.5; 100% focal uptake), continue (SUV <subscript>max</subscript> 6.0; CRP 9.95 mg/L; 90% focal uptake), or stop (SUV <subscript>max</subscript> 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.<br />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.<br />Gov Identifier: NCT01821664.