Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece.
Eur J Vasc Endovasc Surg. 2019 Feb;57(2):292-301. doi: 10.1016/j.ejvs.2018.08.040. Epub 2018 Sep 18.
For the diagnosis of vascular prosthetic graft infection (VPGI), an intra-operative peri-graft biopsy is often required. Controversy exists regarding the use of imaging techniques in the diagnostic process. This study aimed to evaluate the diagnostic accuracy of 18-fluorine fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in VPGI.
A systematic search of electronic databases was conducted, applying a combination of free text and controlled vocabulary searches adapted to thesaurus headings, search operators, and limits to identify studies assessing the use of 18F-FDG PET in the diagnosis of VPGI. A meta-analysis was conducted using a mixed effects logistic regression bivariate model.
Twelve studies were identified reporting a total of 433 prostheses, of which 202 were proven to be infected. Analysis of PET scan was performed using five different methods: graded uptake, focal uptake, maximum standardised uptake value (SUVmax), tissue to background ratio (TBR), and dual time point (DTP). The pooled estimates for sensitivity and specificity for graded uptake were 0.89 (95% CI 0.73-0.96) and 0.61 (95% CI 0.48-0.74), respectively; they were 0.93 (95% CI 0.83-0.97) and 0.78 (95% CI 0.53-0.92) for focal uptake; 0.98 (95% CI 0.42-0.99) and 0.80 (95% CI 0.70-0.88) for SUVmax; 0.57 (95% CI 0.39-0.73) and 0.76 (95% CI 0.64-0.85) for TBR; and 1.00 (95% CI 0.48-1.00) and 0.88 (95% CI 0.68-0.97) for DTP. Sensitivity analysis including studies that investigated the diagnostic accuracy of PET combined with computed tomography (CT) showed higher sensitivity and specificity for focal uptake, graded uptake, and SUVmax than 18F-FDG PET alone.
This meta-analysis suggests that 18F-FDG PET has a high sensitivity in diagnosing VPGI and its accuracy can be further increased by combining PET with CT.
对于血管移植物感染（VPGI）的诊断，通常需要在术中进行移植物周围活检。在诊断过程中，影像学技术的使用存在争议。本研究旨在评估 18 氟氟代脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）在 VPGI 中的诊断准确性。
通过电子数据库进行系统搜索，应用自由文本和受控词汇搜索相结合，适应词库标题、搜索运算符和限制，以确定评估 18F-FDG PET 在 VPGI 诊断中应用的研究。使用混合效应逻辑回归双变量模型进行荟萃分析。
确定了 12 项研究，共报告了 433 个假体，其中 202 个被证实感染。使用五种不同的方法分析 PET 扫描：分级摄取、局灶性摄取、最大标准化摄取值（SUVmax）、组织与背景比（TBR）和双时相（DTP）。分级摄取的敏感性和特异性的汇总估计值分别为 0.89（95%CI 0.73-0.96）和 0.61（95%CI 0.48-0.74）；局灶性摄取的敏感性和特异性分别为 0.93（95%CI 0.83-0.97）和 0.78（95%CI 0.53-0.92）；SUVmax 的敏感性和特异性分别为 0.98（95%CI 0.42-0.99）和 0.80（95%CI 0.70-0.88）；TBR 的敏感性和特异性分别为 0.57（95%CI 0.39-0.73）和 0.76（95%CI 0.64-0.85）；DTP 的敏感性和特异性分别为 1.00（95%CI 0.48-1.00）和 0.88（95%CI 0.68-0.97）。包括研究 PET 与计算机断层扫描（CT）联合诊断准确性的敏感性分析表明，局灶性摄取、分级摄取和 SUVmax 的敏感性和特异性高于单独使用 18F-FDG PET。
这项荟萃分析表明，18F-FDG PET 对诊断 VPGI 具有很高的敏感性，并且通过将 PET 与 CT 结合使用可以进一步提高其准确性。
