Variability of [18F]FDG-PET/LDCT reporting in vascular graft and endograft infection

David J Liesker; Stijn Legtenberg; Paola A Erba; Andor W J M Glaudemans; Clark J Zeebregts; Jean-Paul P M De Vries; Nabil Chakfé; Ben R Saleem; Riemer H J A Slart

doi:10.1007/s00259-023-06349-3

Variability of [¹⁸F]FDG-PET/LDCT reporting in vascular graft and endograft infection

Eur J Nucl Med Mol Imaging. 2023 Nov;50(13):3880-3889. doi: 10.1007/s00259-023-06349-3. Epub 2023 Jul 29.

Authors

Affiliations

¹ Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. d.j.liesker@umcg.nl.
² Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
³ Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
⁴ Department of Nuclear Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
⁵ Department of Vascular Surgery and Kidney Transplantation, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
⁶ Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands.

Abstract

Purpose: ¹⁸F-fluoro-D-deoxyglucose positron emission tomography with low dose and/or contrast enhanced computed tomography ([¹⁸F]FDG-PET/CT) scan reveals high sensitivity for the diagnosis of vascular graft and endograft infection (VGEI), but lower specificity. Reporting [¹⁸F]FDG-PET/CT scans of suspected VGEI is challenging, reader dependent, and reporting standards are lacking. The aim of this study was to evaluate variability of [¹⁸F]FDG-PET/low dose CT (LDCT) reporting of suspected VGEI using a proposed standard reporting format.

Methods: A retrospective cohort study was conducted including all patients with a suspected VGEI (according to the MAGIC criteria) without need for urgent surgical treatment who underwent an additional [¹⁸F]FDG-PET/LDCT scan between 2006 and 2022 at a tertiary referral centre. All [¹⁸F]FDG-PET/LDCT reports were scored following pre-selected criteria that were formulated based on literature and experts in the field. The aim was to investigate the completeness of [¹⁸F]FDG-PET/LDCT reports for diagnosing VGEI (proven according to the MAGIC criteria) and to evaluate if incompleteness of reports influenced the diagnostic accuracy.

Results: Hundred-fifty-two patients were included. Median diagnostic interval from the index vascular surgical procedure until [¹⁸F]FDG-PET/LDCT scan was 35.5 (7.3-73.3) months. Grafts were in 65.1% located centrally and 34.9% peripherally. Based on the pre-selected reporting criteria, 45.7% of the reports included all items. The least frequently assessed criterion was FDG-uptake pattern (40.6%). Overall, [¹⁸F]FDG-PET/LDCT showed a sensitivity of 91%, a specificity of 72%, and an accuracy of 88% when compared to the gold standard (diagnosed VGEI). Lower sensitivity and specificity in reports including ≤ 8 criteria compared to completely evaluated reports were found (83% and 50% vs. 92% and 77%, respectively).

Conclusion: Less than half of the [¹⁸F]FDG-PET/LDCT reports of suspected VGEI met all pre-selected criteria. Incompleteness of reports led to lower sensitivity and specificity. Implementing a recommendation with specific criteria for VGEI reporting is needed in the VGEI-guideline update. This study provides a first recommendation for a concise and complete [¹⁸F]FDG-PET/LDCT report in patients with suspected VGEI.

Keywords: Diagnostic imaging; Reporting; Vascular graft and endograft infection; [18F]FDG-PET/LDCT.

MeSH terms

Fluorodeoxyglucose F18
Humans
Positron Emission Tomography Computed Tomography* / methods
Positron-Emission Tomography
Radiopharmaceuticals
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed
Vascular Diseases*

Substances

Fluorodeoxyglucose F18
Radiopharmaceuticals