Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections

JACC - Journal of the American College of Cardiology, 04/24/2012

Positron emission tomography (PET)/computed tomography (CT) is useful in differentiating between cardiovascular implantable electronic device (CIED) infection and recent post–implant changes. It may guide appropriate therapy.

Methods

  • Three groups were compared.
  • In Group A, 42 patients with suspected CIED infection underwent 18F–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).

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