任方远; 左长京; 汪建华; 孙高峰; 程超; 董爱生; 杨剑

doi:10.3760/cma.j.issn.2095-2848.2019.03.003

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• 临床研究 •

¹⁸F－FDG PET/CT在主动脉腔内修复术后血管移植物感染诊断中的应用

中华核医学与分子影像杂志, 2019,39(3) : 138-141. DOI: 10.3760/cma.j.issn.2095-2848.2019.03.003

摘要

目的

研究主动脉腔内修复术(EVAR)后血管移植物感染(PVGIs)的¹⁸F－脱氧葡萄糖(FDG)PET/CT表现及其诊断价值。

方法

回顾性分析2011年10月至2017年1月27例行PET/CT检查的EVAR术后患者资料[男22例，女5例，年龄21～77(平均42)岁]，其中11例确诊为PVGIs(PVGIs组)，余16例为阴性组。总结2组PET/CT表现，比较PVGIs组PET/CT和主动脉CT血管成像(CTA)的检出情况。采用两样本t检验、Fisher确切概率法比较数据。

结果

PVGIs组11例患者在PET/CT上均表现为血管支架及周围环形、局限性FDG明显摄取，早期显像最大标准摄取值(SUV_max)为14.9±3.3(10.8～21.8)，9例延迟显像SUV_max为13.8±3.4(10.6～19.1)。阴性组表现为支架及周围FDG不摄取或轻度摄取，早期显像SUV_max为1.7±0.8(1.0～2.9)，6例延迟显像SUV_max为1.6±0.7(1.1～2.5)，均低于PVGIs组(t＝12.6、11.8，均P<0.001)。PVGIs组5例患者主动脉CTA诊断为移植物感染，余6例未见明确感染征象，检出率为5/11，低于PET/CT检出率(P<0.05)。6例阴性组患者其他区域有异常FDG摄取，最后被证实为感染性病变(n＝3)和恶性肿瘤(n＝3)。

结论

与主动脉CTA相比，¹⁸F－FDG PET/CT可更灵敏、准确地发现和诊断EVAR术后PVGIs。

引用本文: 任方远, 左长京, 汪建华, 等. ¹⁸F－FDG PET/CT在主动脉腔内修复术后血管移植物感染诊断中的应用 [J] . 中华核医学与分子影像杂志, 2019, 39(3) : 138-141. DOI: 10.3760/cma.j.issn.2095-2848.2019.03.003.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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主动脉腔内修复术(endovascular aortic repair，EVAR)因其微创、术后并发症较少等特点，已得到临床医师和患者的认可。血管移植物感染(prosthetic vascular graft infections, PVGIs)是EVAR术后少见但后果严重的并发症，文献报道PVGIs的发生率在1.5%左右，但PVGIs患者死亡率却高达35%～50%^[1,2]。另外，对于EVAR术后发热患者，除考虑PVGIs外，尚需与其他原因所致发热鉴别，因不同病因对应的临床处置存在巨大差异。因此，及时、正确诊断PVGIs对临床决策至关重要。

贡献者信息

任方远

海军军医大学附属长海医院核医学科，上海　200433

左长京

海军军医大学附属长海医院核医学科，上海　200433

汪建华

宁波大学PET－CT中心　315300

孙高峰

海军军医大学附属长海医院核医学科，上海　200433

程超

海军军医大学附属长海医院核医学科，上海　200433

董爱生

海军军医大学附属长海医院核医学科，上海　200433

杨剑

海军军医大学附属长海医院核医学科，上海　200433

通信作者

左长京

海军军医大学附属长海医院核医学科，上海　200433

Email：changjing.zuo@qq.com

汪建华

宁波大学PET－CT中心　315300

Email：zhangyb_lanzhou@163.com

关键词

主动脉疾病; 外科手术; 人工血管; 感染; 正电子发射断层显像术; 体层摄影术，X线计算机; 脱氧葡萄糖;

利益冲突

利益冲突　所有作者均声明不存在利益冲突

历史

出版日期：2019-03-25

收稿日期：2018-09-07

Clinical Investigation

Value of ¹⁸F-FDG PET/CT in diagnosis of prosthetic vascular graft infection after endovascular aortic repair

Fangyuan Ren, Changjing Zuo, Jianhua Wang, Gaofeng Sun, Chao Cheng, Aisheng Dong, Jian Yang

Published 2019-03-25

Cite as Chin J Nucl Med Mol Imaging, 2019, 39(3): 138-141. DOI: 10.3760/cma.j.issn.2095-2848.2019.03.003

Abstract

Objective

To study the features and clinical value of ¹⁸F-fluorodeoxyglucose (FDG) PET/CT in prosthetic vascular graft infections (PVGIs) after endovascular aortic repair (EVAR).

Methods

Data of 27 patients (22 males and 5 females, age range: 21-77 years, average age: 42 years) who underwent PET/CT imaging after EVAR from October 2011 to January 2017 were studied retrospectively. A total of 11 cases were finally diagnosed as PVGIs (PVGIs group), and the remaining 16 cases were defined as the negative group. PET/CT imaging features were compared between two groups. The detection rates of PET/CT and aortic CT angiography (CTA) for PVGIs were calculated and compared. Two-sample t test and Fisher exact test were used for data analysis.

Results

Significant uptake of FDG around the stents was detected by PET/CT in all patients in PVGIs group. The maximum standardized uptake value (SUV_max ) of 11 patients in early imaging was 14.9±3.3 (10.8-21.8) and that of 9 patients in delayed imaging was 13.8±3.4 (10.6-19.1). Six patients of the negative group underwent the delayed imaging. No uptake or mild uptake of FDG around the stents was observed in negative group, with the SUV_max of 1.7±0.8(1.0-2.9) in early imaging and 1.6±0.7(1.1-2.5) in delayed imaging. SUV_max in negative group was significantly lower than that in PVGIs group (t values: 12.6 and 11.8, both P<0.001). Five patients in PVGIs group were diagnosed as graft infections by the aortic CTA, while the remaining 6 cases showed no definitive infection signs on aortic CTA. The detection rate of aortic CTA was 5/11, which was significantly lower than that of PET/CT (P<0.05). In negative group, 6 patients had abnormal FDG uptakes in other areas and were finally confirmed as infectious lesions (n=3) or malignant tumors (n=3).

Conclusion

Compared with aortic CTA, ¹⁸F-FDG PET/CT is more sensitive and accurate in detection and diagnosis of PVGIs after EVAR.

Key words:

Aortic disease; Surgical procedures, operative; Blood vessel prosthesis; Infection; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Contributor Information

Fangyuan Ren