Whole body [18F]fluorodeoxyglucose positron emission tomography imaging for the diagnosis of pacemaker or implantable cardioverter defibrillator infection: a preliminary prospective study

Abstract

We studied the potential use of [(18) F]fluorodeoxyglucose ((18) F-FDG) whole body positron emission tomography (PET)-computed tomography for the diagnosis of device infection and extension of infection. Twenty-one patients with suspected device infection were prospectively included and compared with 14 controls free of infection. (18) F-FDG uptake on the box and on the leads was visually and quantitatively interpreted (using the maximal standard uptake value). The final diagnosis was obtained either from bacteriological data after device culture (n = 11) or by a 6-month follow-up according to modified Duke's criteria (n = 10). Ten patients finally showed infection on bacteriological study (n = 8) or during follow-up (n = 2). Sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 80%, 100%, 100% and 84.6% on patient-based analysis (presence or absence of infection). They were 100%, 100%, 100% and 100% for boxes, but only 60%, 100%, 100% and 73% for leads. Quantitative analysis could be useful for boxes but not for leads, for which the presence of a mild hot spot was the best criterion of infection. The four false negatives on leads received antibiotics for longer than the six true positives (20 ± 7.2 vs. 3.2 ± 2.3 days, p <0.01). Although the study was not designed for this purpose, management could have been modified by PET results in six of 21 patients. (18) F-FDG PET imaging may be useful for the diagnosis of device infection, and could impact on clinical management. Interpretation of negative cases should be performed with caution if patients have received antibiotics.

Infections of Cardiac Implantable Electronic Devices: Etiology, Prevention and Treatment

“…For leads, sensitivity and specificity are lower, and diagnosis is based upon visualization of mild focal uptake along the leads. Interpretation of negative cases should be cautious, particularly if patients have received prolonged antibiotherapy (Bensimhon et al, 2010).…”

18F-FDG PET/CT now endorsed by guidelines across all types of CIED infection: Evidence limited but growing

“…15,18,22,[26][27][28][29][30][31] However, one caveat is that the majority of studies evaluating diagnostic accuracy in suspected CIED-GPI only include confirmed cases or those with medium-to-high pre-test probability. Paradoxically, patients at the opposite end of the spectrum (with a lower pre-test probability of infection at initial presentation) are generally considered to pose a greater diagnostic challenge and by comparison are relatively underrepresented in these studies; arguably, a novel non-invasive diagnostic tool would be most useful in this group of patients, and further studies assessing the performance of 18 F-FDG in this group are desirable.…”

Positron Emission Tomography/Computed Tomography Imaging in Device Infective Endocarditis

“…For improving the accuracy of the Duke criteria, other imaging modalities such as multidetector computed tomography (CT), 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET), and single-photon emission computed tomography (SPECT) have recently gained importance. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] With the use of retrospective ECG-gated acquisitions and intravenous contrast to enhance vascular structures, currentgeneration CT scanners provide enough spatial detail to visualize the valvular structures at several different phases of the cardiac cycle without motion artifact. The so-called cardiac CT angiography (CTA) is possibly superior to TEE for the evaluation of perivalvular complications such as abscesses and pseudoaneurysms or fistulae.…”