Abstract
PurposeTo determine the impact of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) on clinical management in patients with suspected mycotic aortic aneurysms (MAA).Materials and methodsFor this observational cohort study 101 PET/CT were acquired in 50 patients, thereof 50 for the initial diagnosis/baseline scan, 51 for follow-up. Impact on patient management was defined in three categories: PET/CT results were “confirmed” (by clinical follow-up), “suspected” (conclusive, not confirmed), or “misleading” (proven wrong by follow-up). For clinical follow-up patient data were recorded at the time of imaging, and at the latest recorded clinical visit. It included patient demographics, clinical information, laboratory data, results of microbiology and other diagnostic procedures, information about treatment, and patient’s general health condition.ResultsIn four patients (8%) no clinical follow-up was feasible, the other 46 patients were clinically followed for a median of 898 days (IQR 320–4105). The combined evaluation of all 101 PET/CT demonstrated an impact on patient management in 78,5% of cases (48,5% confirmed, 30% suspected). Results of 21,5% of the PET/CT examinations were misleading. Respective values at baseline and at follow-up were: impact on patient management in 82% and 74,5% (70% and 27.5% confirmed, and 12% and 47% suspected), misleading cases in 18% and 25.5%.ConclusionIn MAA, PET/CT has a high impact on patient management, which is more pronounced with baseline than with follow-up examinations. However, PET/CT results may be misleading in a smaller proportion of cases.
Highlights
The impact of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) on clinical management of cancer patients based on a large prospective data registry has recently shown that physicians change their intended management in 37% of cases after PET/CT [1]
In four patients (8%) no clinical follow-up was feasible, the other 46 patients were clinically followed for a median of 898 days (IQR 320–4105)
The combined evaluation of all 101 PET/CT demonstrated an impact on patient management in 78,5% of cases (48,5% confirmed, 30% suspected)
Summary
The impact of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) on clinical management of cancer patients based on a large prospective data registry has recently shown that physicians change their intended management in 37% of cases after PET/CT [1]. Comparable data for the impact of PET/CT in infectious diseases is scarce. Leroy-Freschini et al [2] described an impact of PET/CT in the management of immunocompromised patients with invasive fungal infections in 55% of their patients at initial staging and in 46% at follow-up. For mycotic aortic aneurysms (MAA), the actual impact of PET/CT on patient management has not been evaluated, yet. MAA are infectious arterial aneurysms, caused by microbial inoculation of aortic endothelium during bacteraemia [4], and which account for 0.7–4.5% of all aortic aneurysms [5]. Surgical and medical treatment of mycotic aortic aneurysms (MAA) is demanding. Evidence indicates that endovascular aortic repair (EVAR) of MAA may be an equivalent treatment option to open surgical treatment [6]. EVAR of MAA inevitably leads to secondary vascular graft infections, requiring long-term antimicrobial therapy
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