18F-fluorodeoxyglucose uptake patterns in positron emission tomography/computed tomography caused by inflammation and/or infection after graft surgery for thoracic aortic dissection

Barbara Hasse; Bruno Ledergerber; Mathias Van Hemelrijck; Michelle Frank; Martin W Huellner; Urs J Muehlematter; Ronny R Buechel; Lars Husmann

doi:10.1016/j.nuclcard.2024.101865

18F-fluorodeoxyglucose uptake patterns in positron emission tomography/computed tomography caused by inflammation and/or infection after graft surgery for thoracic aortic dissection

J Nucl Cardiol. 2024 Apr 27:101865. doi: 10.1016/j.nuclcard.2024.101865. Online ahead of print.

Authors

Barbara Hasse¹, Bruno Ledergerber¹, Mathias Van Hemelrijck², Michelle Frank³, Martin W Huellner⁴, Urs J Muehlematter⁴, Ronny R Buechel⁴, Lars Husmann⁵

Affiliations

¹ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
² Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
³ Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁴ Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁵ Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address: lars.husmann@usz.ch.

PMID: 38679286
DOI: 10.1016/j.nuclcard.2024.101865

Abstract

Background: To identify 18F-fluorodeoxyglucose (FDG) uptake patterns in positron emission tomography/computed tomography (PET/CT) caused by infection, inflammation, surgical material, and/or graft coating.

Methods and results: Of 610 consecutive patients with thoracic aortic graft surgery, 60 patients with 187 PET/CT were retrospectively included. We quantified FDG uptake in all grafts using maximum standardized uptake value (SUVmax) alone and in relation to liver background (SUVratio) and determined the uptake pattern. Mixed linear regression models with random slope and intercept were applied for the analysis of SUVratio over time and generalized estimating equations to analyze the associations with anastomosis uptake. FDG uptake was frequently focal (90%), higher in infected than in noninfected grafts (mean SUVratio 2.19; 95% CI 2.05-2.32 vs. 1.63; 1.46-1.79, P < 0.001), and decreasing slowly over time (SUVratio per year since surgery -0.048; 95% CI -0.15- 0.051, P = 0.34), without a difference in slope between infected and noninfected grafts (P = 0.52). There was no evidence of an interaction between SUVratio and use of BioGlue® surgical adhesive (intercept P = 0.73, slope P = 0.71), or graft coating (gelatin and collagen, all P > 0.7). FDG uptake at the anastomosis was more frequent in noninfected grafts than in infected grafts (66% vs. 21%, odds ratio (OR) 11.34; 95% CI 3.61-35.66, P < 0.001). This effect was attenuated by the use of BioGlue® (OR 5.05; 95% CI 0.45-56.9, P = 0.19).

Conclusions: FDG uptake in PET/CT after thoracic aortic graft surgery is higher in infected grafts than in noninfected grafts. In noninfected grafts, focal uptake is also frequent, mostly anastomosis-associated, not associated with graft coating, and possibly affected by the use of BioGlue®.

Keywords: Infection; Inflammation; PET; vascular imaging.