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Meta-Analysis
. 2021 Jan;48(1):241-253.
doi: 10.1007/s00259-020-04930-8. Epub 2020 Jun 27.

The value of 18F-FDG PET/CT for the diagnosis of device-related infections in patients with a left ventricular assist device: a systematic review and meta-analysis

D Ten Hove  1   2 , G Treglia  3   4   5 , R H J A Slart  6   7 , K Damman  8 , M Wouthuyzen-Bakker  9 , D F Postma  10 , O Gheysens  11 , R J H Borra  6   12 , G Mecozzi  13 , P P van Geel  8 , B Sinha  9 , A W J M Glaudemans  6
Affiliations
Meta-Analysis

The value of 18F-FDG PET/CT for the diagnosis of device-related infections in patients with a left ventricular assist device: a systematic review and meta-analysis

D Ten Hove et al. Eur J Nucl Med Mol Imaging. 2021 Jan.

Abstract

Background: Left ventricular assist devices (LVADs) are increasingly used for the treatment of advanced heart failure. LVADs improve quality of life and decrease mortality, but the driveline carries substantial risk for major infections. These device-related LVAD and driveline infections are difficult to diagnose with conventional imaging. We reviewed and analysed the current literature on the additive value of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) imaging for the diagnosis of LVAD-related infections."

Materials/methods: We performed a systematic literature review using several databases from their inception until the 31st of December, 2019. Studies investigating the diagnostic performance of FDG-PET/CT in patients with suspected LVAD infection were retrieved. After a bias risk assessment using QUADAS-2, a study-aggregate meta-analysis was performed on a per examination-based analysis.

Results: A total of 10 studies were included in the systematic review, eight of which were also eligible for study-aggregate meta-analysis. For the meta-analysis, a total of 256 FDG-PET/CT scans, examining pump/pocket and/or driveline infection, were acquired in 230 patients. Pooled sensitivity of FDG-PET/CT was 0.95 (95% confidence interval (CI) 0.89-0.97) and pooled specificity was 0.91 (95% CI 0.54-0.99) for the diagnosis of device-related infection. For pump/pocket infection, sensitivity and specificity of FDG-PET/CT were 0.97 (95%CI 0.69-1.00) and 0.93 (95%CI 0.64-0.99), respectively. For driveline infection, sensitivity and specificity were 0.96 (95%CI 0.88-0.99) and 0.99 (95%CI 0.13-1.00) respectively. Significant heterogeneity existed across studies for specificity, mostly caused by differences in scan procedures. Predefined criteria for suspicion of LVAD and/or driveline infection were lacking in all included studies.

Conclusions: FDG-PET/CT is a valuable tool for assessment of device-related infection in LVAD patients, with high sensitivity and high, albeit variable, specificity. Standardization of FDG-PET/CT procedures and criteria for suspected device-related LVAD infections are needed for consistent reporting of FDG-PET/CT scans.

Keywords: 18F-FDG PET/CT; LVAD infection; Meta-analysis; Systematic review.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Research question: Diagnostic performance of FDG-PET/CT in patients suspected of LVAD infection Research string:(left ventricular assist device[tiab] OR LVAD[tiab] OR ventricular assist device[tiab] OR VAD[tiab]) And (infection[tiab] OR endocarditis[tiab] or endocarditis[mesh]) AND (positron emission tomography[tiab] OR PET) NOT (case report[tiab])
Fig. 2
Fig. 2
QUADAS-2 risk assessment
Fig. 3
Fig. 3
NLR and PLR forest plots for FDG-PET/CT for LVAD-specific infections (pooled analysis of driveline and LVAD)
Fig. 4
Fig. 4
ROC curves for FDG-PET/CT for LVAD-specific infections
Fig. 5
Fig. 5
Proposed clinical signs/symptoms warranting suspicion of infection of central LVAD components
See this image and copyright information in PMC

References

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