Imaging characteristics and diagnostic accuracy of FDG-PET/CT, contrast enhanced CT and combined imaging in patients with suspected mycotic or inflammatory abdominal aortic aneurysms

Lars Husmann; Martin W Huellner; Hannes Gruenig; Bruno Ledergerber; Michael Messerli; Carlos-A Mestres; Zoran Rancic; Barbara Hasse

doi:10.1371/journal.pone.0272772

Imaging characteristics and diagnostic accuracy of FDG-PET/CT, contrast enhanced CT and combined imaging in patients with suspected mycotic or inflammatory abdominal aortic aneurysms

PLoS One. 2022 Aug 9;17(8):e0272772. doi: 10.1371/journal.pone.0272772. eCollection 2022.

Authors

Lars Husmann¹, Martin W Huellner¹, Hannes Gruenig¹, Bruno Ledergerber², Michael Messerli¹, Carlos-A Mestres³, Zoran Rancic⁴, Barbara Hasse²

Affiliations

¹ Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
² Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
³ Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁴ Department of Vascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Abstract

Purpose: To evaluate the diagnostic accuracy and specific imaging characteristics of positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (PET/CT), contrast enhanced CT (CE-CT), and a combined imaging approach (CE-PET/CT) in patients with infectious/mycotic (MAA), inflammatory (IAA), and non-infected, non-inflammatory abdominal aortic aneurysm (AAA).

Materials and methods: In this single-center retrospective cohort study, all imaging data sets of 29 consecutive patients with clinically suspected MAA or IAA were anonymised with different, reshuffled identification numbers and retrospectively and independently analysed by two experienced readers, blinded to all clinical patient data. Readers determined the presence or absence and MAA, IAA and AAA and of predefined imaging characteristics (e.g. fluid collection), and measured metabolic activity and wall thickness of all aneurysms. A multidisciplinary team of specialists served as standard of reference and re-evaluated every clinical case, considering all clinical, laboratory, microbiological, histopathological and imaging results, including all follow-up examinations.

Results: Diagnostic accuracy was higher in PET/CT as compared to CE-CT in differentiating AAA from MAA and IAA: area under the receiver operating characteristic curve (AUC-ROC) 0.81 (95% confidence intervals 0.69-0.92) and 0.63 (0.52-0.74) (P = 0.027). Specific imaging characteristics were significantly associated with different types of aneurysms (P<0.05), i.e. very high metabolic activity and dorsal sparing of metabolic activity in PET/CT and wall thickening in CE-CT were indicative for IAA; fat stranding and fluid collections in CE-CT were associated with MAA; while low metabolic acitivity and absence of wall thickening in PET/CT, and less fat stranding and absence of wall thickening in CE-CT were indicative for non-infected, non-inflammatory AAA.

Conclusion: Specific imaging characteristics of PET/CT and CE-CT may be helpful in differentiating between MAA, IAA, and non-infected, non-inflammatory AAA.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aortic Aneurysm, Abdominal* / diagnostic imaging
Contrast Media
Fluorodeoxyglucose F18* / metabolism
Humans
Positron Emission Tomography Computed Tomography / methods
Positron-Emission Tomography / methods
Radiopharmaceuticals
Retrospective Studies

Substances

Contrast Media
Radiopharmaceuticals
Fluorodeoxyglucose F18

Grants and funding

This study was supported by the Swiss National Science Foundation (SNF) grant 320030_184918/1. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.