Appearance of aseptic vascular grafts after endovascular aortic repair on [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography

doi:10.4329/wjr.v15.i8.241

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Aug 28, 2023 (publication date) through Feb 27, 2026

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World Journal of Radiology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Radiol. Aug 28, 2023; 15(8): 241-249
Published online Aug 28, 2023. doi: 10.4329/wjr.v15.i8.241

Appearance of aseptic vascular grafts after endovascular aortic repair on [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography

Paige Bennett, Maria Bernadette Tomas, Christopher F Koch, Kenneth J Nichols, Christopher J Palestro

Paige Bennett, Department of Radiology, LIJMC Northwell Health, New Hyde Park, NY 11040, United States

Paige Bennett, Maria Bernadette Tomas, Kenneth J Nichols, Christopher J Palestro, Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States

Christopher F Koch, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Northwell Health, New Hyde Park, NY 11040, United States

Author contributions: Bennett P and Nichols KJ wrote the manuscript; Palestro C, Nichols KJ, and Tomas MB designed the research study; Tomas MB performed image analysis and chart review; Koch CF performed chart review; Nichols KJ, Tomas MB and Palestro C analyzed the data; and all authors have read and approved the final manuscript.

Institutional review board statement: Our Institutional Review Board approved this retrospective study. All data were handled in compliance with the Health Insurance Portability and Accountability Act of 1996.

Informed consent statement: The requirement to obtain informed consent was waived.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The original anonymous dataset is available upon reasonable request from the corresponding author at pbennett1@northwell.edu.

Corresponding author: Paige Bennett, MD, Professor, Department of Radiology, LIJMC Northwell Health, Rm C204, 27005 76^th Avenue, New Hyde Park, NY 11040, United States. pbennett1@northwell.edu

Received: March 28, 2023
Peer-review started: March 28, 2023
First decision: June 1, 2023
Revised: June 15, 2023
Accepted: July 27, 2023
Article in press: July 27, 2023
Published online: August 28, 2023
Processing time: 148 Days and 13.3 Hours

ARTICLE HIGHLIGHTS

Research background

On [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), the inflammatory response caused by endoprosthetic stent grafts after endovascular aneurysm repair (EVAR) can show increased 18F-FDG uptake. However, the visual, semiquantitative, and temporal characteristics of uninfected, or aseptic, endovascular aneurysm grafts has not been fully elucidated.

Research motivation

Characterization of aseptic vascular stent grafts on 18F-FDG PET/CT is important to distinguish the normal inflammatory response to graft material vs vascular graft infection.

Research objectives

The purpose of this study was to characterize aseptic vascular stent grafts over time.

Research methods

In this observational retrospective cohort study, patients with EVAR who underwent 18F-FDG PET/CT for routine oncologic indications were included. Any patients with suspected or confirmed vascular stent graft infection were excluded. Visual and semiquantitative region of interest (ROI) analysis with maximum standardized uptake value (SUV_max) and graft-to-background ascending aorta uptake ratios (URs) of the grafts were obtained. We compared visual analysis and semiquantitative values, grouped by age of grafts, ROI locations, and graft materials.

Research results

Characteristics of an aseptic vascular stent graft on 18F-FDG PET/CT include graft SUV_max values within 10%-20% of the ascending aorta background SUV_max. The SUV_max of older aseptic grafts can be as much as 30% above background. The visual uptake pattern of diffuse, homogeneous uptake less than liver was seen in 98% of aseptic vascular stent grafts.

Research conclusions

Aseptic vascular stent grafts post endovascular repair show mildly increased 18F-FDG uptake, with mean graft-to-background URs of 1.1-1.2. Diffuse homogeneous 18F-FDG uptake less than liver in vascular stent grafts is particularly reassuring as a sign of an uninfected graft.

Research perspectives

This study reinforces prior research in characterizing aseptic vascular grafts on 18F-FDG PET/CT.