Usefulness of Fluorine-18 Positron Emission Tomography/Computed Tomography for Identification of Cardiovascular Implantable Electronic Device Infections

• Published in: Journal of the American College of Cardiology 2012-05, Vol.59 (18), p.1616-1625
• Main Authors: Sarrazin, Jean-François, MD, Philippon, François, MD, Tessier, Michel, MD, Guimond, Jean, MD, Molin, Franck, MD, Champagne, Jean, MD, Nault, Isabelle, MD, Blier, Louis, MD, Nadeau, Maxime, Charbonneau, Lyne, RN, Trottier, Mikaël, MD, O'Hara, Gilles, MD
• Format: Article
• Language: English
• Subjects: Aged; Arrhythmias, Cardiac - therapy; Blood; Cardiology; Cardiovascular; Cardiovascular disease; Cardiovascular Infections - diagnosis; Cardiovascular Infections - epidemiology; Cardiovascular Infections - etiology; defibrillator; Defibrillators, Implantable - microbiology; Diagnosis, Differential; extraction; Female; Fluorine; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; infection; Internal Medicine; Male; Middle Aged; Morbidity - trends; Mortality; Multimodal Imaging - utilization; Myocarditis - diagnosis; Myocarditis - epidemiology; Myocarditis - etiology; pacemaker; PET scan; Positron-Emission Tomography; Prospective Studies; Prosthesis-Related Infections - diagnosis; Quebec - epidemiology; Radiopharmaceuticals; Reproducibility of Results; Software; Tomography; Tomography, X-Ray Computed
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.11.059

Objectives This study evaluated the usefulness of fluorodesoxyglucose marked by fluorine-18 (18 F-FDG) positron emission tomography (PET) and computed tomography (CT) in patients with suspected cardiovascular implantable electronic device (CIED) infection. Background CIED infection is sometimes challenging to diagnose. Because extraction is associated with significant morbidity/mortality, new imaging modalities to confirm the infection and its dissemination would be of clinical value. Methods Three groups were compared. In Group A, 42 patients with suspected CIED infection underwent18 F-FDG PET/CT. Positive PET/CT was defined as abnormal uptake along cardiac devices. Group B included 12 patients without infection who underwent PET/CT 4 to 8 weeks post-implant. Group C included 12 patients implanted for >6 months without infection who underwent PET/CT for another indication. Semi-quantitative ratio (SQR) was obtained from the ratio between maximal uptake and lung parenchyma uptake. Results In Group A, 32 of 42 patients with suspected CIED infection had positive PET/CT. Twenty-four patients with positive PET/CT underwent extraction with excellent correlation. In 7 patients with positive PET/CT, 6 were treated as superficial infection with clinical resolution. One patient with positive PET/CT but negative leukocyte scan was considered false positive due to Dacron pouch. Ten patients with negative-PET/CT were treated with antibiotics and none has relapsed at 12.9 ± 1.9 months. In Group B, patients had mild uptake seen at the level of the connector. There was no abnormal uptake in Group C patients. Median SQR was significantly higher in Group A (A = 2.02 vs. B = 1.08 vs. C = 0.57; p < 0.001). Conclusions PET/CT is useful in differentiating between CIED infection and recent post-implant changes. It may guide appropriate therapy.