van Rijsewijk Nick D, Helthuis Jasper H G, Glaudemans Andor W J M, Wouthuyzen-Bakker Marjan, Prakken Niek H J, Liesker David J, Saleem Ben R, Slart Riemer H J A
Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
Medical School Twente, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands.
Biology (Basel). 2023 Feb 5;12(2):251. doi: 10.3390/biology12020251.
Vascular graft and endograft infections (VGEI) cause a serious morbidity and mortality burden. F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) imaging is frequently used in the diagnostic workup, but the additional value of abnormal (F-FDG active and/or enlarged) locoregional lymph nodes is unknown. In this retrospective study, the additional diagnostic value of abnormal locoregional lymph nodes on F-FDG PET/CT imaging for VGEI was evaluated, including 54 patients with a culture-proven VGEI (defined according to the Management of Aortic Graft Infection [MAGIC] group classification) and 25 patients without VGEI. F-FDG PET/CT was qualitatively and quantitatively assessed for tracer uptake and pattern at the location of the vascular graft, and locoregional lymph node uptake and enlargement (>10 mm). F-FDG uptake intensity and pattern independently predicted the presence of VGEI by logistic regression (Χ: 46.19, < 0.001), with an OR of 7.38 (95% CI [1.65, 32.92], = 0.009) and 18.32 (95% CI [3.95, 84.88], < 0.001), respectively. Single visual assessment of abnormal locoregional lymph nodes predicted the presence of VGEI with a sensitivity of 35%, specificity of 96%, PPV of 95%, and NPV of 41%. The visual assessment of abnormal lymph nodes after qualitative assessment of F-FDG uptake intensity and pattern at the vascular graft location did not independently predict the presence of VGEI by logistic regression (Χ: 3.60, = 0.058; OR: 8.25, 95% CI [0.74, 63.37], = 0.096). In conclusion, detection of abnormal locoregional lymph nodes on F-FDG PET/CT has a high specificity (96%) and PPV (95%) for VGEI. However, it did not add to currently used F-FDG PET/CT interpretation criteria.
血管移植物和腔内移植物感染（VGEI）会造成严重的发病和死亡负担。氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）成像常用于诊断检查，但局部区域异常（F-FDG活性增高和/或肿大）淋巴结的附加价值尚不清楚。在这项回顾性研究中，评估了F-FDG PET/CT成像上局部区域异常淋巴结对VGEI的附加诊断价值，研究对象包括54例经培养证实为VGEI的患者（根据主动脉移植物感染管理[MAGIC]组分类定义）和25例无VGEI的患者。对F-FDG PET/CT在血管移植物位置的示踪剂摄取和模式进行定性和定量评估，以及局部区域淋巴结摄取和肿大情况（>10mm）。通过逻辑回归分析，F-FDG摄取强度和模式可独立预测VGEI的存在（Χ：46.19，P<0.001），优势比分别为7.38（95%可信区间[1.65,32.92]，P = 0.009）和18.32（95%可信区间[3.95,84.88]，P<0.001）。对局部区域异常淋巴结进行单一视觉评估预测VGEI存在的敏感性为35%，特异性为96%，阳性预测值为95%，阴性预测值为41%。在对血管移植物位置的F-FDG摄取强度和模式进行定性评估后，对异常淋巴结进行视觉评估，通过逻辑回归分析不能独立预测VGEI的存在（Χ：3.60，P = 0.058；优势比：8.25，95%可信区间[0.74,63.37]，P = 0.096）。总之，F-FDG PET/CT上检测到局部区域异常淋巴结对VGEI具有较高的特异性（96%）和阳性预测值（95%）。然而，它并未增加目前使用的F-FDG PET/CT解读标准的内容。
