Abstract
BackgroundThe diagnosis of cardiac implantable electronic device (CIED) infection is challenging because of its variable presentations. We studied the value of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the detection of CIED infection. Methods and resultsThirty patients with suspected CIED infection underwent 18F-FDG-PET/CT. The control group was ten patients with asymptomatic CIED who underwent cancer-related 18F-FDG-PET/CT. 18F-FDG-PET/CT was evaluated visually, semiquantitatively as maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). Final diagnosis of CIED infection was based on clinical and bacteriological data. 18F-FDG-PET/CT was visually positive in all 9 patients with recent (≤ 8 weeks) implantation of CIED, but only 4 had confirmed CIED infection. 18F-FDG-PET/CT was true positive in 9 out of 21 cases with remote implantation of CIED and false positive in 3 (14.3%) cases. 18F-FDG-PET/CT was also false positive in 3 (30%) cases of control group. The SUVmax of the pocket area was significantly higher in patients with CIED infection than in the control group (4.8 ± 2.4 vs 2.0 ± .8, P < .001). By using the cut-off value of TBR ≥ 1.8, sensitivity of 18F-FDG-PET/CT for the diagnosis of CIED infection in patients with remote implantation was 90% and specificity 73%, PPV 75%, and NPV 89%. Conclusions18F-FDG-PET/CT is a sensitive but nonspecific method in the diagnosis of CIED infection.
Highlights
Clinical symptoms and manifestation of cardiac implantable electronic device (CIED) infections vary widely depending on causative microorganisms, time from implantation and patient-related factors
We evaluated patients with local signs of CIED infection after recent (B 8 weeks) or remote ([8 weeks) implantation of the device as well as patients presenting with fever of unknown origin, but with no local signs of CIED infection
Vegetations or other findings indicating endocarditis were not seen on valves
Summary
Clinical symptoms and manifestation of cardiac implantable electronic device (CIED) infections vary widely depending on causative microorganisms, time from implantation and patient-related factors. Symptoms can be mild and unspecific leading to delayed diagnosis associated with increasing risk of complications. Extraction of the CIED system is the recommended therapy for definitive CIED infection in most cases. Extraction of the whole CIED system is associated with a mortality rate of .8% and 1.5-2% risk of major complications.[3,4] accurate diagnosis of CIED infection is important for timely therapy. The diagnosis of cardiac implantable electronic device (CIED) infection is challenging because of its variable presentations. We studied the value of 2-[18F]fluoro-2-deoxyD-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the detection of CIED infection
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