Diagnostic Impact of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and White Blood Cell SPECT/Computed Tomography in Patients With Suspected Cardiac Implantable Electronic Device Chronic Infection.
BACKGROUND
Cardiac implantable electronic devices (CIEDs) chronic infection diagnosis is challenging because the clinical presentation is frequently misleading and echocardiography may be inconclusive. The aim of this study was to evaluate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and radiolabeled white blood cells single photon emission CT/CT in a cohort of patients who underwent both scans for suspicion of CIED infection and inconclusive routine investigations.


METHODS
Forty-eight consecutive patients with suspicion of CIED infection who underwent both 18F-fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT in a time span ≤30 days were retrospectively included. The final diagnosis of CIED infection by the endocarditis expert team was based on the modified Duke-Li classification at the end of follow-up. 18F-Fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT scans were independently analyzed blinded to the patients' medical record.


RESULTS
In the overall study population, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were respectively 80%, 91%, 80%, and 91% for 18F-fluorodeoxyglucose positron emission tomography/CT and 60%, 100%, 100%, and 85% for white blood cell single photon emission CT/CT. Addition of a positive nuclear imaging scan as a major criterion markedly improved the Duke-Li classification at admission. Semiquantitative parameters did not allow to discriminate between definite and rejected CIED infection. Prolonged antibiotic therapy before imaging tended to decrease the sensitivity for both techniques.


CONCLUSIONS
Nuclear imaging can improve the diagnostic performances of the Duke-Li score at admission in a selected population of patients with suspected CIED infection, particularly when the infection was initially graded as possible. Whenever possible, imaging should be performed before or early after antibiotic initiation.
['Calais|Jérémie|J|', 'Touati|Aziza|A|', 'Grall|Nathalie|N|', 'Laouénan|Cédric|C|', 'Benali|Khadija|K|', 'Mahida|Besma|B|', 'Vigne|Jonathan|J|', 'Hyafil|Fabien|F|', 'Iung|Bernard|B|', 'Duval|Xavier|X|', 'Lepage|Laurent|L|', 'Le Guludec|Dominique|D|', 'Rouzet|François|F|']
D000368:Aged D002908:Chronic Disease D017147:Defibrillators, Implantable D004696:Endocarditis D005260:Female D019788:Fluorodeoxyglucose F18 D006801:Humans D007962:Leukocytes D008297:Male D010138:Pacemaker, Artificial D000072078:Positron Emission Tomography Computed Tomography D016459:Prosthesis-Related Infections D019275:Radiopharmaceuticals D015203:Reproducibility of Results D012189:Retrospective Studies D012680:Sensitivity and Specificity D000072098:Single Photon Emission Computed Tomography Computed Tomography
infection diagnosis cardiac pacemaker, artificial implantable cardioverter-defibrillators positron-emission tomography radionuclide imaging