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. 2021 Dec;28(6):2992-3003.
doi: 10.1007/s12350-020-02256-4. Epub 2020 Jul 31.

18F-FDG positron emission tomography/computed tomography of cardiac implantable electronic device infections

Soile Pauliina Salomäki  1 , Antti Saraste  2   3   4   5 , Jukka Kemppainen  2   3   6 , Saija Hurme  7 , Juhani Knuuti  2   3 , Pirjo Nuutila  8   2   3   5 , Marko Seppänen  2   3   6 , Anne Roivainen  2   3 , Juhani Airaksinen  4   5 , Tiina Salo  4 , Jarmo Oksi  8   5 , Laura Pirilä  8   5 , Ulla Hohenthal  8   5
Affiliations

18F-FDG positron emission tomography/computed tomography of cardiac implantable electronic device infections

Soile Pauliina Salomäki et al. J Nucl Cardiol. 2021 Dec.

Abstract

Background: 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-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the detection of CIED infection.

Methods and results: Thirty 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%.

Conclusions: 18F-FDG-PET/CT is a sensitive but nonspecific method in the diagnosis of CIED infection.

Keywords: Infection; PET; diagnostic and prognostic application; image interpretation; molecular imaging.

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Figures

Figure 1
Figure 1
Patient #23 had fever of unknown origin, but no symptom in CIED area. The generator had been changed 1.5 years before. 18F-FDG-PET/CT showed uptake in lead, SUVmax 5.2 (Panel A and B). Bacterial culture from removed CIED system yielded Staphylococcus epidermidis.
Figure 2
Figure 2
CIED infection case classification at admission and at the end of the follow-up of patients with suspicion of CIED infection and implantation/intervention of CIED > 8 weeks earlier (group 2 and group 3)
Figure 3
Figure 3
Patient #10 had CIED implanted 8 years ago and now two months after elective CABG procedure he had pain, redness and swelling in pocket area. 18F-FDG-PET/CT showed uptake in pocket (SUVmax 7.1) (Panel A, red arrow). There were also physiological uptake in sternotomy wound (SUVmax 5.3) (Panel A, yellow arrow). The CIED system was removed and infection was confirmed as bacterial culture which yielded Staphylococcus epidermidis. Panel B sagittal CT scan, Panel C sagittal fusion, Panel D sagittal PET
See this image and copyright information in PMC

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