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Master Thesis

Comparaison des performances de la scintigraphie aux leucocytes marqués et de la tomographie par émission de positons au 18F-FDG dans le diagnostic des infections de prothèses vasculaires : étude prospective menée au CHU de Bordeaux portant sur 34 patients inclus sur une période de 3 ans

Abstract : Introduction: prosthetic vascular graft infections (PVGI) are associated with high mortality rates. The diagnosis is often difficult, especially in latent infections. To improve the outcome of the medical and surgical treatment, an early and definite diagnosis is critical, and actual diagnosis criteria are often insufficient. The present study compared the accuracy of positron emission tomography/computed tomography with 18F-fludeoxyglucose (18F-FDG PET/CT) and radiolabeled leucocyte scintigraphy single-photon emission computed tomography (SPECT) for the diagnosis of PVGI. Methods: we conducted a prospective monocentric study on patients undergoing scintigraphy and 18F-FDG PET/CT for a suspected PVGI between April 2013 and June 2016 at the Bordeaux University Hospital, France. Patients with thoracic aortic grafts were excluded. Diagnosis of PVGI was assessed by the Fitzgerald’s criteria at the end of the follow-up. Accuracy of both examinations was compared for every graft of each patient, using receiver-operating characteristic (ROC) curve analysis. We also compared the accuracy of three different visual scales for 18F-FDG PET/CT interpretation. Images were independently interpreted by two different nuclear medicine physicians blinded to patients clinical and other imaging data. Results : thirty-four patients were included, 14 had PVGI. An antibiotic treatment was started before nuclear imaging for 14 patients, including eight patients with a PVGI which was confirmed later. Ninety-three grafts were analyzed, 18 were infected. Regarding the three evaluated visual scales, our local scale had a better accuracy than two other ones (ROC areas under the curve [AUC] = 0.871, 0.76 and 0.777, respectively, p = 0.04 and 0.7). Applied on all grafts, accuracy of scintigraphy was significantly higher than PET/CT (ROC AUC = 0.904, CI 95% [0.823-0.985], and 0.871, CI 95% [0.786-0.955], respectively, p = 0.022). Accuracy of scintigraphy was not significantly different from PET/CT in thrombosed grafts (ROC AUC 0.983 and 0.903, respectively, p = 0.32). Inter-observer agreement was excellent for both examinations. Conclusion: this study highlighted a better accuracy of radiolabeled leucocyte scintigraphy compared to PET/CT for diagnosing PVGI, with an excellent inter-observer agreement.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01657486
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Submitted on : Wednesday, December 6, 2017 - 5:50:24 PM
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Mathilde Puges. Comparaison des performances de la scintigraphie aux leucocytes marqués et de la tomographie par émission de positons au 18F-FDG dans le diagnostic des infections de prothèses vasculaires : étude prospective menée au CHU de Bordeaux portant sur 34 patients inclus sur une période de 3 ans. Médecine humaine et pathologie. 2017. ⟨dumas-01657486⟩

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