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Review
. 2015 Jan-Feb;61(1):e5-10.
doi: 10.1097/MAT.0000000000000167.

Role of gallium SPECT-CT in the diagnosis of left ventricular assist device infections

Dana T Levy  1 , Grace Y Minamoto, Raphaella Da Silva, Yoram A Puius, Naomi Peck, Daniel Goldstein, David D'Alessandro, Victoria A Muggia
Affiliations
Review

Role of gallium SPECT-CT in the diagnosis of left ventricular assist device infections

Dana T Levy et al. ASAIO J. 2015 Jan-Feb.

Abstract

Infection remains a well-established complication after the placement of left ventricular assist devices (LVADs). Defining the extent of infection is a challenging task as there are few effective imaging modalities and no standardized guidelines regarding imaging in the diagnosis of device-related infections (DRIs). The use of gallium with single photon emission tomography-computed tomography (Ga-SPECT-CT) has not been previously reported in localizing DRIs. We reviewed the charts and images of five patients with LVADs who underwent Ga-SPECT-CT for the diagnosis of various types of DRIs. Gallium SPECT-CT further clarified the extent of infections among LVAD patients, allowing for patient-specific tailored treatments including surgical debridement. Gallium SPECT-CT is a useful tool when diagnosing LVAD infections and could potentially be the imaging modality of choice in the near future. With improved imaging studies, such as Ga-SPECT-CT, allowing for earlier and more accurate diagnoses of DRIs, the outcome of such infections is likely to improve.

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Conflict of interest statement

Remaining authors have no funding or conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Planar whole body anterior image shows a focal area of intense radiotracer activity overlying the right abdomen (A). This activity corresponds to skin contamination on the single photon emission tomography images, which is consistent with a superficial driveline infection (B and C).
Figure 2.
Figure 2.
The planar whole body anterior image shows tracer activity along the driveline (A). Fused single photon emission tomography-computed tomography transaxial and coronal images confirm tracer concentration in the site of the driveline and the left ventricular assist device (B and C).
Figure 3.
Figure 3.
Planar whole body anterior image shows more extensive driveline infection than seen on prior study (A). Fused single photon emission tomography-computed tomography transaxial (B) and coronal (C) images confirm tracer concentration uptake along the driveline and along the entire course of the driveline to the point of entry of the left ventricular assist device.
Figure 4.
Figure 4.
A planar whole body anterior image demonstrates a curvilinear uptake anteriorly in the right upper quadrant. This uptake represents an infected driveline, whereas the uptake in anterior midline was likely related to prior median sternotomy (A). Fused single photon emission tomography-computed tomography transaxial and coronal images confirm tracer concentration along the driveline (B and C).
Figure 5.
Figure 5.
Planar whole body anterior image demonstrates uptake in the right upper quadrant representing an infected driveline (A). Fused single photon emission tomography-computed tomography transaxial (B) and coronal (C) images confirm tracer concentration in the site of the driveline in the right upper quadrant. Uptake in the midsternal region may be secondary to prior median sternotomy. There is also uptake demonstrated in the lower left chest, which may be consistent with extension of driveline infection to include the left ventricular assist device.
Figure 6.
Figure 6.
Partial improvement in the previously seen infectious foci along the driveline; however, residual focus of infection has progressed toward the left ventricular assist device in the left lower chest on whole body planar image (A). Corresponding fused single photon emission tomography-computed tomography transaxial (B) and coronal (C) images demonstrate increased activity specifically along the deep driveline.
See this image and copyright information in PMC

References

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