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Puttini I, Kapalla M, Braune A, Michler E, Kröger J, Lutz B, Sakhalihasan N, Trenner M, Biro G, Weber W, Rössel T, Reeps C, Eckstein HH, Wolk S, Knappich C, Notohamiprodjo S, Busch A. Aortic Vascular Graft and Endograft Infection-Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics. J Clin Med 2024; 13:269. [PMID: 38202276 PMCID: PMC10779700 DOI: 10.3390/jcm13010269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/01/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Vascular graft/endograft infection (VGEI) is a serious complication after aortic surgery. This study investigates VGEI and patient characteristics, PET/CT quantification before surgical or conservative management of VGEI and post-intervention outcomes in order to identify patients who might benefit from such a procedure. PET standard uptake values (SUV) were quantitatively assessed and compared to a non-VGEI cohort. The primary endpoints were in-hospital mortality and aortic reintervention-free survival at six months. Ninety-three patients (75% male, 65 ± 10 years, 82% operated) were included. The initial operation was mainly for aneurysm (67.7%: 31% EVAR, 12% TEVAR, 57% open aortic repair). Thirty-two patients presented with fistulae. PET SUVTLR (target-to-liver ratio) showed 94% sensitivity and 89% specificity. Replacement included silver-coated Dacron (21.3%), pericardium (61.3%) and femoral vein (17.3%), yet the material did not influence the overall survival (p = 0.745). In-hospital mortality did not differ between operative and conservative treatment (19.7% vs. 17.6%, p = 0.84). At six months, 50% of the operated cohort survived without aortic reintervention. Short- and midterm morbidity and mortality remained high after aortic graft removal. Neither preoperative characteristics nor the material used for reconstruction influenced the overall survival, and, with limitations, both the in-hospital and midterm survival were similar between the surgically and conservatively managed patients.
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Affiliation(s)
- Ilaria Puttini
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany
| | - Marvin Kapalla
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital, Technical University of Dresden, 01307 Dresden, Germany
| | - Anja Braune
- Nuclear Medicine Department, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
| | - Enrico Michler
- Nuclear Medicine Department, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
| | - Joselyn Kröger
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital, Technical University of Dresden, 01307 Dresden, Germany
| | - Brigitta Lutz
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital, Technical University of Dresden, 01307 Dresden, Germany
| | - Natzi Sakhalihasan
- Department of Cardiovascular and Thoracic Surgery, University of Liège, 4000 Liège, Belgium
| | - Matthias Trenner
- Division of Vascular Medicine, St. Josefs-Hospital Wiesbaden, 65189 Wiesbaden, Germany
| | - Gabor Biro
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Thomas Rössel
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, 01307 Dresden, Germany
| | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital, Technical University of Dresden, 01307 Dresden, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany
| | - Steffen Wolk
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital, Technical University of Dresden, 01307 Dresden, Germany
| | - Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany
| | - Susan Notohamiprodjo
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital, Technical University of Dresden, 01307 Dresden, Germany
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Liesker DJ, Legtenberg S, Erba PA, Glaudemans AWJM, Zeebregts CJ, De Vries JPPM, Chakfé N, Saleem BR, Slart RHJA. Variability of [ 18F]FDG-PET/LDCT reporting in vascular graft and endograft infection. Eur J Nucl Med Mol Imaging 2023; 50:3880-3889. [PMID: 37507493 PMCID: PMC10611872 DOI: 10.1007/s00259-023-06349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE 18F-fluoro-D-deoxyglucose positron emission tomography with low dose and/or contrast enhanced computed tomography ([18F]FDG-PET/CT) scan reveals high sensitivity for the diagnosis of vascular graft and endograft infection (VGEI), but lower specificity. Reporting [18F]FDG-PET/CT scans of suspected VGEI is challenging, reader dependent, and reporting standards are lacking. The aim of this study was to evaluate variability of [18F]FDG-PET/low dose CT (LDCT) reporting of suspected VGEI using a proposed standard reporting format. METHODS A retrospective cohort study was conducted including all patients with a suspected VGEI (according to the MAGIC criteria) without need for urgent surgical treatment who underwent an additional [18F]FDG-PET/LDCT scan between 2006 and 2022 at a tertiary referral centre. All [18F]FDG-PET/LDCT reports were scored following pre-selected criteria that were formulated based on literature and experts in the field. The aim was to investigate the completeness of [18F]FDG-PET/LDCT reports for diagnosing VGEI (proven according to the MAGIC criteria) and to evaluate if incompleteness of reports influenced the diagnostic accuracy. RESULTS Hundred-fifty-two patients were included. Median diagnostic interval from the index vascular surgical procedure until [18F]FDG-PET/LDCT scan was 35.5 (7.3-73.3) months. Grafts were in 65.1% located centrally and 34.9% peripherally. Based on the pre-selected reporting criteria, 45.7% of the reports included all items. The least frequently assessed criterion was FDG-uptake pattern (40.6%). Overall, [18F]FDG-PET/LDCT showed a sensitivity of 91%, a specificity of 72%, and an accuracy of 88% when compared to the gold standard (diagnosed VGEI). Lower sensitivity and specificity in reports including ≤ 8 criteria compared to completely evaluated reports were found (83% and 50% vs. 92% and 77%, respectively). CONCLUSION Less than half of the [18F]FDG-PET/LDCT reports of suspected VGEI met all pre-selected criteria. Incompleteness of reports led to lower sensitivity and specificity. Implementing a recommendation with specific criteria for VGEI reporting is needed in the VGEI-guideline update. This study provides a first recommendation for a concise and complete [18F]FDG-PET/LDCT report in patients with suspected VGEI.
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Affiliation(s)
- David J Liesker
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Stijn Legtenberg
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Paola A Erba
- Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
- Department of Nuclear Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andor W J M Glaudemans
- Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Jean-Paul P M De Vries
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Ben R Saleem
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Riemer H J A Slart
- Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
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Nayak P, Bentivoglio V, Varani M, Signore A. Three-Dimensional In Vitro Tumor Spheroid Models for Evaluation of Anticancer Therapy: Recent Updates. Cancers (Basel) 2023; 15:4846. [PMID: 37835541 PMCID: PMC10571930 DOI: 10.3390/cancers15194846] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Advanced tissue engineering processes and regenerative medicine provide modern strategies for fabricating 3D spheroids. Several different 3D cancer models are being developed to study a variety of cancers. Three-dimensional spheroids can correctly replicate some features of solid tumors (such as the secretion of soluble mediators, drug resistance mechanisms, gene expression patterns and physiological responses) better than 2D cell cultures or animal models. Tumor spheroids are also helpful for precisely reproducing the three-dimensional organization and microenvironmental factors of tumors. Because of these unique properties, the potential of 3D cell aggregates has been emphasized, and they have been utilized in in vitro models for the detection of novel anticancer drugs. This review discusses applications of 3D spheroid models in nuclear medicine for diagnosis and therapy, immunotherapy, and stem cell and photodynamic therapy and also discusses the establishment of the anticancer activity of nanocarriers.
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Affiliation(s)
- Pallavi Nayak
- Nuclear Medicine Unit, University Hospital Sant’Andrea, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00189 Roma, Italy; (V.B.); (M.V.); (A.S.)
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Lauri C, Campagna G, Aloisi F, Posa A, Iezzi R, Sirignano P, Taurino M, Signore A. How to combine CTA, 99mTc-WBC SPECT/CT, and [ 18F]FDG PET/CT in patients with suspected abdominal vascular endograft infections? Eur J Nucl Med Mol Imaging 2023; 50:3235-3250. [PMID: 37367965 PMCID: PMC10542742 DOI: 10.1007/s00259-023-06309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE We aimed at comparing 99mTc-HMPAO white blood cells (99mTc-WBC) scintigraphy, 18fluorine-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) and CT angiography (CTA) in patients with suspected abdominal vascular graft or endograft infection (VGEI). Moreover, we attempted to define a new visual score for interpreting [18F]FDG PET/CT scans aiming at increasing its specificity. METHODS We prospectively compared 99mTc-WBC SPECT/CT, [18F]FDG PET/CT, and CTA in 26 patients with suspected abdominal VGEI. WBC scans were performed and interpreted according to EANM recommendations. [18F]FDG PET/CT studies were assessed with both qualitative (Sah's scale and new visual score) and semi-quantitative analyses. CTA images were interpreted according to MAGIC criteria. Microbiology, histopathology or a clinical follow-up of at least 24 months were used to achieve final diagnosis. RESULTS Eleven out of 26 patients were infected. [18F]FDG PET/CT showed 100% sensitivity and NPV, with both scoring systems, thus representing an efficient tool to rule out the infection. The use of a more detailed scoring system provided statistically higher specificity compared to the previous Sah's scale (p = 0.049). 99mTc-WBC SPECT/CT provided statistically higher specificity and PPV than [18F]FDG PET/CT, regardless the interpretation criteria used and it can be, therefore, used in early post-surgical phases or to confirm or rule out a PET/CT finding. CONCLUSIONS After CTA, patients with suspected late VGEI should perform a [18F]FDG PET/CT given its high sensitivity and NPV. However, given its lower specificity, positive results should be confirmed with 99mTc-WBC scintigraphy. The use of a more detailed scoring system reduces the number of 99mTc-WBC scans needed after [18F]FDG PET/CT. Nevertheless, in suspected infections within 4 months from surgery, 99mTc-WBC SPECT/CT should be performed as second exam, due to its high accuracy in differentiating sterile inflammation from infection.
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Affiliation(s)
- Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Giuseppe Campagna
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Francesco Aloisi
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Alessandro Posa
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia – Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Roberto Iezzi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia – Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Diagnostic and Interventional Radiology Unit, Gemelli Molise Hospital, Campobasso, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pasqualino Sirignano
- Vascular Surgery Unit, Sant’Andrea Hospital, Department of General and Specialistic Surgery, Sapienza” University of Rome, 00161 Rome, Italy
| | - Maurizio Taurino
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
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