Accuracy of 18 F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections

Utility of F-FDG PET/CT in diagnosing infective endocarditis (IE) associated with cardiac implantable electronic devices (CIEDs) is not well established. Current ESC guidelines recommend the use of FDG-PET imaging in patients with CIEDs and positive blood cultures, but the number of studies evaluati...

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Published in:Journal of nuclear cardiology 2022-04, Vol.29 (2), p.594
Main Authors: Jerónimo, Adrián, Olmos, Carmen, Vilacosta, Isidre, Ortega-Candil, Aida, Rodríguez-Rey, Cristina, Pérez-Castejón, María Jesús, Fernández-Pérez, Cristina, Pérez-García, Carlos Nicolás, García-Arribas, Daniel, Ferrera, Carlos, Carreras, José Luis
Format: Article
Language:English
Subjects:
Defibrillators, Implantable - adverse effects
Electronics
Endocarditis - diagnostic imaging
Endocarditis, Bacterial
Fluorodeoxyglucose F18
Humans
Pacemaker, Artificial - adverse effects
Positron Emission Tomography Computed Tomography - methods
Positron-Emission Tomography
Prosthesis-Related Infections - diagnostic imaging
Radiopharmaceuticals
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Summary:Utility of F-FDG PET/CT in diagnosing infective endocarditis (IE) associated with cardiac implantable electronic devices (CIEDs) is not well established. Current ESC guidelines recommend the use of FDG-PET imaging in patients with CIEDs and positive blood cultures, but the number of studies evaluating the diagnostic performance of FDG-PET imaging in these patients remain limited. Our objective was to assess the diagnostic yield of F-FDG PET/CT in patients with suspected CIED infections, differentiating between pocket infection (PI) and lead infection (CIED-IE). From 2013 to 2018, all patients (n = 63) admitted to a hospital with suspected CIED infection were prospectively recruited, undergoing a diagnostic work-up including a PET/CT. Explanted devices and material from the pocket were cultured. 14 cases corresponded to isolated PI and 13 were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, sensitivity and specificity of PET/CT for CIED-IE were 38.5% and 98.0%, respectively. Positive (19.2) and negative (0.6) likelihood ratio values, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis when negative. For PI, sensitivity and specificity were 72.2% and 95.6%, respectively. The yield of F-FDG PET/CT for suspected CIED infections differs depending on the site of infection. Due to very high specificity but poor sensitivity, negative studies must be interpreted with caution if the suspicion of CIED-IE is high.
ISSN:1532-6551