ABSTRACT
OBJETIVO: La infección de las prótesis vasculares es una complicación temible por su alta morbimortalidad, en la que el diagnóstico precoz es imprescindible. Evaluamos la utilidad de la gammagrafía con leucocitos marcados con 99mTc-HMPAO y SPECT/TC (GLM-SPECT/TC) en el diagnóstico de esta patología. MATERIALES Y MÉTODOS: Analizamos retrospectivamente 30 GLM-SPECT/TC realizadas en pacientes con sospecha de infección de prótesis vasculares. Se consideró como resultado positivo la captación del radiofármaco en el área protésica con una intensidad superior a la del hígado o la médula ósea de raquis y pelvis. RESULTADOS: El diagnóstico final de infección, basado en los criterios de Fitzgerald, se estableció en 10pacientes, siendo la gammagrafía positiva en 11. No se obtuvieron falsos negativos. Los valores de sensibilidad y especificidad fueron 100% y 95%, respectivamente, con un VPP del 91% y un VPN del 100%. Veinticinco pacientes contaban también con un TC previo a la gammagrafía, que en 9 de los casos fue positivo (4FP). Los resultados de sensibilidad y especificidad del TC fueron del 62,5% y del 76%, con un VPP del 55,6% y un VPN del 81,3%. El diagnóstico de infección conllevó la exéresis del material protésico en 8 casos (todos ellos con confirmación microbiológica), mientras que los 2 restantes fueron tratados únicamente con antibioterapia debido a un alto riesgo quirúrgico. CONCLUSIONES: La GLM-SPECT/TC es una prueba de gran utilidad que presenta una alta precisión diagnóstica en la sospecha de infección de prótesis vasculares
AIM: Vascular graft infection is a rare complication with a high morbidity and mortality. Early diagnosis is essential to establish an adequate treatment. We assess the accuracy of 99mTc-WBC scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. MATERIALS AND METHODS: We retrospectively analyzed thirty 99mTc-WBC scintigraphies with SPECT/CT performed in thirty patients with suspicion of vascular prosthesis infection. Studies were considered positive for graft infection if the intensity of activity involving the graft was greater than the liver or bone marrow activity (spine and pelvis). RESULTS: Final diagnosis of infection was established in 10 patients, based on Fitzgerald criteria. Scintigraphy was positive in 11 patients. No false negatives were obtained. The values of sensitivity and specificity were 100% and 95%, respectively, with a PPV of 91% and a NPV of 100%. Twenty five patients had a CT performed prior to scintigraphy, in 9 cases the result was positive and in the remaining 16 was negative. CT sensitivity and specificity obtained in our study were 62.5% and 76% respectively, with a PPV of 55.6% and a NPV of 81.3%. Diagnosis of infection led to prosthesis exeresis in 8 cases (all of them had a positive microbiological study of the extracted material), while the remaining 2 patients were treated with antibiotic therapy alone due to high surgical risk. CONCLUSION: Our results suggest a high accuracy for 99mTc-WBC scintigraphy with SPECT/CT in the assessment of clinically suspected arterial graft infection
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Tomography, Emission-Computed, Single-Photon , Prosthesis-Related Infections/diagnostic imaging , Blood Vessel Prosthesis/microbiology , Radionuclide Imaging/methods , Leukocytes , Retrospective StudiesABSTRACT
AIM: Vascular graft infection is a rare complication with a high morbidity and mortality. Early diagnosis is essential to establish an adequate treatment. We assess the accuracy of 99mTc-WBC scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. MATERIALS AND METHODS: We retrospectively analyzed thirty 99mTc-WBC scintigraphies with SPECT/CT performed in thirty patients with suspicion of vascular prosthesis infection. Studies were considered positive for graft infection if the intensity of activity involving the graft was greater than the liver or bone marrow activity (spine and pelvis). RESULTS: Final diagnosis of infection was established in 10 patients, based on Fitzgerald criteria. Scintigraphy was positive in 11 patients. No false negatives were obtained. The values of sensitivity and specificity were 100% and 95%, respectively, with a PPV of 91% and a NPV of 100%. Twenty five patients had a CT performed prior to scintigraphy, in 9 cases the result was positive and in the remaining 16 was negative. CT sensitivity and specificity obtained in our study were 62.5% and 76% respectively, with a PPV of 55.6% and a NPV of 81.3%. Diagnosis of infection led to prosthesis exeresis in 8 cases (all of them had a positive microbiological study of the extracted material), while the remaining 2 patients were treated with antibiotic therapy alone due to high surgical risk. CONCLUSION: Our results suggest a high accuracy for 99mTc-WBC scintigraphy with SPECT/CT in the assessment of clinically suspected arterial graft infection.
Subject(s)
Blood Vessel Prosthesis/adverse effects , Leukocytes , Prosthesis-Related Infections/diagnostic imaging , Radionuclide Imaging/methods , Radiopharmaceuticals , Single Photon Emission Computed Tomography Computed Tomography/methods , Technetium Tc 99m Exametazime , Vascular Grafting , Vasculitis/diagnostic imaging , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Blood Vessel Prosthesis/microbiology , Device Removal , False Negative Reactions , False Positive Reactions , Female , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Prosthesis-Related Infections/microbiology , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed , Vasculitis/microbiologyABSTRACT
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