这项研究的目的是调查与专家共识MAGIC标准相比,18F-氟代脱氧葡萄糖(FDG)正电子发射断层扫描(PET)用于检测胸主动脉移植物感染(AGI)的诊断率。
前瞻性招募了临床怀疑患有胸腔AGI的患者。将AGI的一致MAGIC标准与FDGPET成像的发现进行了比较。根据临床/手术验证MAGIC标准,放射学,和微生物/实验室预定义的主要和次要参数。FDG图像使用半定量视觉分级评分(VGS,异常≥3),病灶摄取和定量最大标准FDG摄取值(SUVmax,异常≥7.3),和目标-背景FDG比(TBRmax,异常≥4.2)。
在35名怀疑患有胸椎AGI的患者中,MAGIC诊断标准为AGI阳性25例(71%),阴性10例(29%)。27例(77%)患者FDGPET显像异常。31例患者(88.6%)的FDG成像异常和正常符合MAGIC标准。在4名患者中,FDG成像结果与MAGIC标准不一致。通过ROC分析,对于VGS,MAGIC检测AGI的最佳FDG截止值≥3,SUVmax≥7.3,TBRmax≥4.2,与MAGIC标准的一致性为88.6%,85.7%,88.6%的病人,分别。两个或两个以上FDG成像参数(VGS,局灶性摄取,SUVmax,和TBRmax)的最高诊断一致性为91.4%。AGI的VGS逆赔率比为7.14。在抗生素治疗期间重复FDGPET显像的6例选择性患者中,有4例,随着炎症实验室标志物的改善,FDG定量成像值随着时间的推移而改善.
FDGPET/CT显像,使用(半)定量成像参数,与AGI的专家共识MAGIC标准高度一致。这些数据表明定量FDG/CT成像的潜在补充作用,不仅是为了检测AGI,还可以监测对抗生素治疗的反应。
The aim of this study was to investigate the diagnostic yield of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for detecting thoracic aortic graft infection (AGI) in comparison to expert
consensus MAGIC criteria.
Patients suspected clinically of having thoracic-AGI were prospectively recruited.
Consensus MAGIC criteria for AGI were compared to findings on FDG PET imaging. MAGIC criteria were verified against clinical/surgical, radiological, and microbiological/laboratory predefined major and minor parameters. FDG images were interpreted using a semiquantitative visual grading score (VGS, abnormal ≥ 3), focal uptake and quantitative maximum standard FDG uptake value (SUVmax, abnormal ≥ 7.3), and target-to-background FDG ratio (TBRmax, abnormal ≥ 4.2).
Of 35 patients suspected of having thoracic-AGI, MAGIC diagnostic criteria were positive for AGI in 25 patients (71%) and negative in 10 (29%). FDG PET imaging was abnormal in 27 patients (77%). Abnormal and normal FDG imaging findings were concordant with MAGIC criteria in 31 patients (88.6%). In 4 patients, FDG imaging results were discordant with MAGIC criteria. By ROC analysis, optimal FDG cut-off values for detecting AGI by MAGIC were ≥ 3 for VGS, ≥ 7.3 for SUVmax and ≥ 4.2 for TBRmax, with concordance with MAGIC criteria in 88.6%, 85.7%, and 88.6% of patients, respectively. Two or more FDG imaging parameters (VGS, focal uptake, SUVmax, and TBRmax) yielded highest diagnostic concordance of 91.4%. VGS inverse odds ratio for AGI was 7.14. In 4 of 6 selective patients who had repeat FDG PET imaging during antibiotic treatment, quantitative FDG imaging values improved over time with associated improvement of laboratory markers of inflammation.
FDG PET/CT imaging, using (semi-)quantitative imaging parameters, showed high concordance with expert
consensus MAGIC criteria for AGI. These data suggest a potential complementary role of quantitative FDG/CT imaging, not only to detect AGI, but also to monitor response to antibiotic treatment.