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Clark J Zeebregts - One of the best experts on this subject based on the ideXlab platform.
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diagnostic imaging in vascular Graft Infection a systematic review and meta analysis
European Journal of Vascular and Endovascular Surgery, 2018Co-Authors: Eline Reinders I Folmer, Andor W J M Glaudemans, Ben R Saleem, Riemer H J A Slart, Gerdine C I Von Meijenfeldt, Maarten J Van Der Laan, Clark J ZeebregtsAbstract:Background Vascular Graft Infection (VGI), a serious complication in vascular surgery, has a high morbidity and mortality rate. The diagnosis is complicated by non-specific symptoms and challenged by the variable accuracy of different imaging techniques. The objective of this study was to determine the diagnostic value of various imaging techniques to diagnose VGI. Methods A systematic review was conducted according to the PRISMA guidelines. Data sources included PubMed/Medline, Embase, and Cochrane from January 1997 until October 2017. Observational cohort studies were included. A meta-analysis was conducted on several imaging modalities: computed tomography with or without angiography (CT(A)), 18F-fluoro- d -deoxyglucose positron emission tomography with or without low dose or contrast enhanced CT (FDG-PET(/CT)), and white blood cell scintigraphy with or without single photon emission computed tomography combined with low dose CT (WBC (SPECT/CT)). Results Of 4259 papers, 14 articles were included, containing eight prospective and six retrospective articles. CTA (I2 7.4%), FDG-PET (I2 36.5%), and FDG-PET/CT (I2 36.6%) showed negligible to moderate heterogeneity, while WBC scintigraphy ± SPECT/CT (I2 78.6%) showed considerable heterogeneity. Pooled sensitivity for CTA was 0.67 (95% CI 0.57–0.75), in contrast to FDG-PET of 0.94 (95% CI 0.88–0.98), FDG-PET/CT of 0.95 (95% CI 0.87–0.99), WBC scintigraphy of 0.90 (95% CI 0.85–0.94), and WBC scintigraphy with SPECT/CT of 0.99 (95% CI 0.92–1.00). The pooled specificities were for CTA 0.63 (95% CI 0.48–0.76), FDG-PET 0.70 (95% CI 0.59–0.79), FDG-PET/CT 0.80 (95% CI 0.69–0.89), WBC scintigraphy 0.88 (95% CI 0.81–1.94), and WBC scintigraphy SPECT/CT 0.82 (95% CI 0.57–0.96). Pre- and post-test results showed that WBC SPECT/CT favours FDG-PET/CT, with a positive post-test probability of 96% versus 83%. Conclusion This meta-analysis suggests the diagnostic performance of WBC scintigraphy combined with SPECT/CT is the greatest in diagnosing VGI. However, it is a time consuming technique and not always available. Therefore FDG-PET/CT may be favourable as the initial imaging technique. The use of solitary CTA in diagnosing VGI seems to be obsolete.
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18f fluorodeoxyglucose positron emission tomography ct scanning in diagnosing vascular prosthetic Graft Infection
BioMed Research International, 2014Co-Authors: Ben R Saleem, Riemer H J A Slart, Robert A Pol, Michel M P J Reijnen, Clark J ZeebregtsAbstract:Vascular prosthetic Graft Infection (VPGI) is a severe complication after vascular surgery. CT-scan is considered the diagnostic tool of choice in advanced VPGI. The incidence of a false-negative result using CT is relatively high, especially in the presence of low-grade Infections. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scanning has been suggested as an alternative for the diagnosis and assessment of infectious processes. Hybrid 18F-FDG PET/CT has established the role of 18F-FDG PET for the assessment of suspected VPGI, providing accurate anatomic localization of the site of Infection. However, there are no clear guidelines for the interpretation of the uptake patterns of 18F-FDG as clinical tool for VPGI. Based on the available literature it is suggested that a linear, diffuse, and homogeneous uptake should not be regarded as an Infection whereas focal or heterogeneous uptake with a projection over the vessel on CT is highly suggestive of Infection. Nevertheless, 18F-FDG PET and 18F-FDG PET/CT can play an important role in the detection of VPGI and monitoring response to treatment. However an accurate uptake and pattern recognition is warranted and cut-off uptake values and patterns need to be standardized before considering the technique to be the new standard.
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accuracy of fdg pet ct in the diagnostic work up of vascular prosthetic Graft Infection
European Journal of Vascular and Endovascular Surgery, 2010Co-Authors: Janneke L M Bruggink, Andor W J M Glaudemans, Ben R Saleem, Robbert Meerwaldt, H Alkefaji, T R Prins, Riemer H J A Slart, Clark J ZeebregtsAbstract:Abstract Objectives To investigate the diagnostic accuracy of fluoro-2-deoxy- d -glucose positron emission tomography (FDG-PET) compared with computed tomography (CT) scanning and added value of fused FDG-PET–CT in diagnosing vascular prosthetic Graft Infection. Design Prospective cohort study with retrospective analysis. Materials Twenty five patients with clinically suspected vascular prosthetic Infection underwent CT and FDG-PET scanning. Methods Two nuclear medicine physicians assessed the FDG-PET scans; all CT scans were assessed by two radiologists. Fused FDG-PET/CT were judged by the radiologist and the nuclear medicine physician. The concordance between CT and FDG-PET and the inter-observer agreement between the different readers were investigated. Results Fifteen patients had a proven Infection by culture. Single FDG-PET had the best results (sensitivity 93%, specificity 70%, positive predictive value 82% and negative predictive value 88%). For CT, these values were 56%, 57%, 60% and 58%, respectively. Fused CT and FDG-PET imaging also showed high sensitivity and specificity rates and high positive and negative values. Inter-observer agreement for FDG-PET analysis was excellent (kappa = 1.00) and moderate for CT and fused FDG-PET–CT analysis (0.63 and 0.66, respectively). Conclusion FDG-PET scanning showed a better diagnostic accuracy than CT for the detection of vascular prosthetic Infection. This study suggests that FDG-PET provides a useful tool in the work-up for diagnosis of vascular prosthetic Graft Infection.
O Leroy - One of the best experts on this subject based on the ideXlab platform.
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intra abdominal aortic Graft Infection prognostic factors associated with in hospital mortality
BMC Infectious Diseases, 2014Co-Authors: Matthias Garot, Patrick Devos, P Y Delannoy, Agnes Meybeck, Beatrice Sarrazbournet, Piervito Delia, T Descrivan, O LeroyAbstract:Background Mortality associated with aortic Graft Infection is considerable. The gold standard for surgical treatment remains explantation of the Graft. However, prognostic factors associated with early mortality due to this surgical procedure are not well-known.
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intra abdominal aortic Graft Infection prognostic factors associated with in hospital mortality
BMC Infectious Diseases, 2014Co-Authors: Matthias Garot, Patrick Devos, Agnes Meybeck, Beatrice Sarrazbournet, Piervito Delia, T Descrivan, Pierreyves Delannoy, O LeroyAbstract:Mortality associated with aortic Graft Infection is considerable. The gold standard for surgical treatment remains explantation of the Graft. However, prognostic factors associated with early mortality due to this surgical procedure are not well-known. Retrospective analysis of patients admitted in our center between January 2006 and October 2011 for aortic Graft Infection. The primary endpoint was in-hospital mortality. A bivariate analysis of characteristics of patients associated with in-hospital outcome was performed. Twenty five evaluable patients were studied. All patients were male. Their mean age was 67 ± 8.4 years. Most of them (92%) had severe underlying diseases. An in situ prosthetic Graft replacement, mainly using cryopreserved arterial alloGrafts, was performed in all patients, excepted one who underwent extra-anatomic bypass. Causative organisms were identified in 23 patients (92%). The in-hospital mortality rate was 48%. Among pre-operative characteristics, age ≥ 70 years, creatinine ≥ 12 mg/L and C reactive protein ≥ 50 mg/L were significantly associated with in-hospital mortality. Hospital mortality rates increased with the number of risk factor present on ICU admission, and were 0%, 14.3%, 85.7% and 100% for 0, 1, 2 and 3 factors, respectively. The only intra-operative factor associated with prognosis was an associated intestinal procedure due to aorto-enteric fistula. SAPS II, SOFA score and occurrence of medical or surgical complications were postoperative characteristics associated with in-hospital mortality. Morbidity and mortality associated with surgical approach of aortic Graft Infections are considerable. Age and values of creatinine and C Reactive protein on hospital admission appear as the most important determinant of in hospital mortality. They could be taken into account for guiding the surgical strategy.
Akihiko Usui - One of the best experts on this subject based on the ideXlab platform.
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detection of thoracic aortic prosthetic Graft Infection with 18f fluorodeoxyglucose positron emission tomography computed tomography
European Journal of Cardio-Thoracic Surgery, 2013Co-Authors: Yoshiyuki Tokuda, Hideki Oshima, Yoshimori Araki, Yuji Narita, Masato Mutsuga, Katsuhiko Kato, Akihiko UsuiAbstract:OBJECTIVES: To investigate the diagnostic value of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting thoracic aortic prosthetic Graft Infection. METHODS: Nine patients with clinically suspected thoracic aortic Graft Infection underwent FDG-PET/CT scanning. In these patients, the diagnoses could not be confirmed using conventional modalities. The patients’ clinical courses were retrospectively reviewed. RESULTS: On the basis of surgical, microbiological and clinical follow-up findings, the aortic Grafts were considered infected in 4 patients and not infected in 5. All 4 patients with Graft Infection (root: 2 cases, arch: 1 case and descending: 1 case) eventually underwent in situ re-replacement. Two of the 4 patients also had abdominal Grafts; however, only the thoracic Grafts were replaced because uptake was low around the abdominal Grafts. The maximal standardized uptake value (SUVmax) in the periGraft area was higher in the infected group than in the non-infected group (11.4 ± 4.5 vs 6.9 ± 6.4), although the difference was not statistically significant. According to the receiver operating characteristic analysis, SUVmax >8 appeared to be the cut-off value in distinguishing the two groups (sensitivity: 1.0 and specificity: 0.8). CONCLUSIONS: FDG-PET/CT is useful for confirming the presence of Graft Infection by detecting high uptake around Grafts and excluding other causes of inflammation. An SUVmax value greater than 8 around a Graft suggests the presence of Graft Infection. In addition, FDG-PET/CT can be used to clarify the precise extent of Infection. This is especially useful if multiple separated prosthetic Grafts have been implanted.
Anders Wanhainen - One of the best experts on this subject based on the ideXlab platform.
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detection of aortic Graft Infection by 18 fluorodeoxyglucose positron emission tomography combined with computed tomography
Journal of Vascular Surgery, 2007Co-Authors: Gustaf Tegler, Jens Sorensen, Martin Bjorck, Irina Savitcheva, Anders WanhainenAbstract:Functional in vivo molecular imaging is provided with 18-fluorodeoxyglucose positron emission tomography (FDG-PET), which can detect cells with high glucose turnover. FDG-PET is an established imaging tool in oncology but has also been used in infectious and inflammatory diseases. PET combined with computed tomography (PET/CT) shows the metabolic activity with precise anatomic localization. More than 2000 scanners have now been installed worldwide, and with better availability, this hybrid method has the potential to become an important imaging tool in the management of suspected aortic Graft Infections, especially in patients with low-grade Graft Infection. We report a patient with a suspected aortic Graft Infection that was confirmed and anatomically localized by FDG-PET/CT. An extra-anatomic bypass and extirpation of the aortic Graft was performed. The perioperative location of the Graft Infection coincided exactly with the place of FDG uptake shown on PET/CT. The patient had an uneventful postoperative recovery and did well during 6 months of follow-up.
Matthias Garot - One of the best experts on this subject based on the ideXlab platform.
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intra abdominal aortic Graft Infection prognostic factors associated with in hospital mortality
BMC Infectious Diseases, 2014Co-Authors: Matthias Garot, Patrick Devos, P Y Delannoy, Agnes Meybeck, Beatrice Sarrazbournet, Piervito Delia, T Descrivan, O LeroyAbstract:Background Mortality associated with aortic Graft Infection is considerable. The gold standard for surgical treatment remains explantation of the Graft. However, prognostic factors associated with early mortality due to this surgical procedure are not well-known.
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intra abdominal aortic Graft Infection prognostic factors associated with in hospital mortality
BMC Infectious Diseases, 2014Co-Authors: Matthias Garot, Patrick Devos, Agnes Meybeck, Beatrice Sarrazbournet, Piervito Delia, T Descrivan, Pierreyves Delannoy, O LeroyAbstract:Mortality associated with aortic Graft Infection is considerable. The gold standard for surgical treatment remains explantation of the Graft. However, prognostic factors associated with early mortality due to this surgical procedure are not well-known. Retrospective analysis of patients admitted in our center between January 2006 and October 2011 for aortic Graft Infection. The primary endpoint was in-hospital mortality. A bivariate analysis of characteristics of patients associated with in-hospital outcome was performed. Twenty five evaluable patients were studied. All patients were male. Their mean age was 67 ± 8.4 years. Most of them (92%) had severe underlying diseases. An in situ prosthetic Graft replacement, mainly using cryopreserved arterial alloGrafts, was performed in all patients, excepted one who underwent extra-anatomic bypass. Causative organisms were identified in 23 patients (92%). The in-hospital mortality rate was 48%. Among pre-operative characteristics, age ≥ 70 years, creatinine ≥ 12 mg/L and C reactive protein ≥ 50 mg/L were significantly associated with in-hospital mortality. Hospital mortality rates increased with the number of risk factor present on ICU admission, and were 0%, 14.3%, 85.7% and 100% for 0, 1, 2 and 3 factors, respectively. The only intra-operative factor associated with prognosis was an associated intestinal procedure due to aorto-enteric fistula. SAPS II, SOFA score and occurrence of medical or surgical complications were postoperative characteristics associated with in-hospital mortality. Morbidity and mortality associated with surgical approach of aortic Graft Infections are considerable. Age and values of creatinine and C Reactive protein on hospital admission appear as the most important determinant of in hospital mortality. They could be taken into account for guiding the surgical strategy.
