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Diagnostic accuracy of PET/CT and contrast enhanced CT in patients with suspected infected aortic aneurysms

Husmann, Lars; Huellner, Martin W; Ledergerber, Bruno; Eberhard, Nadia; Kaelin, Marisa B; Anagnostopoulos, Alexia; Kudura, Ken; Burger, Irene A; Mestres, Carlos-A; Rancic, Zoran; Hasse, Barbara (2020). Diagnostic accuracy of PET/CT and contrast enhanced CT in patients with suspected infected aortic aneurysms. European Journal of Vascular and Endovascular Surgery, 59(6):972-981.

Abstract

OBJECTIVE: Infected aortic aneurysms are highly lethal, and management is very demanding, requiring an early diagnosis. The aim of this study was to evaluate the diagnostic accuracy of positron emission tomography/computed tomography with $^{18}$F-fluorodeoxyglucose (PET/CT) and contrast enhanced CT (CE-CT) in patients with suspected infected aortic aneurysms.
METHODS: PET/CT was performed in patients with clinically suspected infected aortic aneurysms, and additional CE-CT was performed if feasible. Diagnostic accuracy was assessed by two independent readers using a four point grading score for both imaging modalities. Maximum standardised uptake values (SUV$_{max}$) were calculated for quantitative measurements of metabolic activity in PET/CT. The reference standard was a combination of clinical presentation, laboratory findings, and imaging.
RESULTS: Ten patients were included prospectively in the study, 24 retrospectively; 16 patients (47%) prior to the start of antimicrobial treatment and all 34 patients prior to any vascular intervention. Thirteen of the 34 patients had an infected aortic aneurysm (38%). Proven infected aortic aneurysms were all metabolically active on PET/CT with a median SUV$_{max}$ of 6.6 (interquartile range 4.7-21.8). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT for the diagnosis of infected aortic aneurysm was 100%, 71%, 68%, 100%, and 82%, for reader 1 and 85%, 71%, 65%, 88%, and 77%, for reader 2. Respective values for CE-CT, performed in 20 patients (59%), were 63%, 75%, 63%, 75%, and 70%, for reader 1 and 88%, 50%, 54%, 86%, and 65%, for reader 2.
CONCLUSION: The diagnostic accuracy of PET/CT in the detection of infected aortic aneurysms (n = 13) is high, and higher than CE-CT. While PET/CT demonstrates an excellent sensitivity, its specificity is hampered because of false positive findings.

Additional indexing

Contributors:Vasgra Cohort
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiac Surgery
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
04 Faculty of Medicine > University Hospital Zurich > Clinic for Vascular Surgery
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Health Sciences > Cardiology and Cardiovascular Medicine
Uncontrolled Keywords:18F-FDG; Computed tomography angiography; Data accuracy; Infected aneurysm; Infection; PET-CT
Language:English
Date:June 2020
Deposited On:02 Sep 2020 17:36
Last Modified:23 Oct 2024 01:40
Publisher:Elsevier
ISSN:1078-5884
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.ejvs.2020.01.032
PubMed ID:32340877

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