Physiological Appearance of Hybrid FDG-Positron Emission Tomography/Computed Tomography Imaging Following Uncomplicated Endovascular Aneurysm Sealing Using the Nellix Endoprosthesis

Erik Groot Jebbink, Leo H van Den Ham, Beau B J van Woudenberg, Riemer H J A Slart, Clark J Zeebregts, Ton J M Rijnders, Jan-Willem H P Lardenoije, Michel M P J Reijnen, Erik Groot Jebbink, Leo H van Den Ham, Beau B J van Woudenberg, Riemer H J A Slart, Clark J Zeebregts, Ton J M Rijnders, Jan-Willem H P Lardenoije, Michel M P J Reijnen

Abstract

Purpose: To investigate the physiological uptake of hybrid fluorine-18-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) before and after an uncomplicated endovascular aneurysm sealing (EVAS) procedure as a possible tool to diagnose EVAS graft infection and differentiate from postimplantation syndrome. Materials and Methods: Eight consecutive male patients (median age 78 years) scheduled for elective EVAS were included in the prospective study (ClinicalTrials.gov identifier NCT02349100). FDG-PET/CT scans were performed in all patients before the procedure and 6 weeks after EVAS. The abdominal aorta was analyzed in 4 regions: suprarenal, infrarenal neck, aneurysm sac, and iliac. The following parameters were obtained for each region: standard uptake value (SUV), tissue to background ratio (TBR), and visual examination of FDG uptake to ascertain its distribution. Demographic data were obtained from medical files and scored based on reporting standards. Results: Visual examination showed no difference between pre- and postprocedure FDG uptake, which was homogenous. In the suprarenal region no significant pre- and postprocedure differences were observed for the SUV and TBR parameters. The infrarenal neck region showed a significant decrease in the SUV and no significant decrease in the TBR. The aneurysm sac and iliac regions both showed a significant decrease in SUV and TBR between the pre- and postprocedure scans. Conclusion: Physiological FDG uptake after EVAS was stable or decreased with regard to the preprocedure measurements. Future research is needed to assess the applicability and cutoff values of FDG-PET/CT scanning to detect endograft infection after EVAS.

Keywords: aortic aneurysm; endovascular aneurysm sealing; fluorine-18-fluorodeoxyglucose; graft infection; positron emission tomography / computed tomography.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Michel M. P. J. Reijnen has received speaker honoraria from Endologix, Terumo Aortic, and Bently and research grants from Endologix Inc.

Figures

Figure 1.
Figure 1.
Overview of measurement regions. The arrows indicate the direction of measurement.
Figure 2.
Figure 2.
FDG-PET/CT fused-image axial slice of the abdomen including the region of interest (white lines) on the first slice of the infrarenal neck region showing infrarenal anatomy (A) before and (B) after endovascular aneurysm sealing; CT, computed tomography; FDG, fluorine-18-fluorodeoxyglucose; PET, positron emission tomography.

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