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

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(SUVmax)为14.9±3.3(10.8～21.8),9例延迟显像SUVmax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SUVmax为1.7±0.8(1.0～2.9),6例延迟显像SUVmax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.%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 (SUVmax) 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 SUVmax of 1.7±0.8(1.0--2.9) in early imaging and 1.6±0.7(1.1-2.5) in delayed imaging.SUVmax 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.