Infected aortic aneurysms are diagnosed on the basis of a positive bacterial blood culture, clinical evidence of inflammation, and morphologic findings on computed tomography (CT). However, preoperative diagnosis is often difficult because blood cultures are frequently negative and patients can be asymptomatic. Because therapeutic approaches differ significantly, it is vital to determine whether an aortic aneurysm is infected prior to surgery.
There are some literatures which have shown that fluorodeoxyglucose positron emission tomography-computed tomography (F-FDG-PET/CT) examination is useful in the diagnosis of infected aortic aneurysms.
However, I wonder whether or not FDG-PET/CT takes place of the conventional imaging diagnosis methods?
【References】
* Clin Nucl Med. 2008 Jul;33(7):492-5.
F-18 FDG PET/CT in the management of infected abdominal aortic aneurysm due to Salmonella.
* Ann Vasc Surg. 2014 Apr;28(3):575-8.
Fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography for diagnosis of infected aortic aneurysms.
As you have already elaborated that positive bacterial blood culture, clinical evidence of inflammation, and Computed tomography (CT) findings are useful for diagnosing infected aortic aneurysm. However, positive bacterial blood culture and clinical evidence of inflammation are non-specific and can have origin from other sources, apart for infected aortic aneurysm. CT, being an anatomical imaging can give only subtle clues as to whether infection is present or not. On the other hand, FDG PET CT is an functional imaging. If there is FDG uptake at site of aortic aneurysm with clinical signs of inflammation, it is almost certain that it is infected aortic aneurysm. However absence of FDG uptake might not rule out infective etiology. In current scenario, it is the best investigation to look for infective aortic aneurysm.
The diagnosis of infected (= mycotic) AAA is at times difficult. The current European Guidelines (Wanhainen et at, Eur J Vasc Endovasc Surg (2019) 57, 8e93) do not discuss PET in the diagnosis. In single case reports (LR Leon . 2010 Jan;44(1):5-13.Vasc Endovasc Surg doi: 10.1177/1538574409344225) FDG-PET was considered helpful.
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