title: Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections.
abstract: OBJECTIVE
  This study evaluated the usefulness of fluorodesoxyglucose marked by fluorine-18 ((18)F-FDG) positron emission tomography (PET) and computed tomography (CT) in patients with suspected cardiovascular implantable electronic device (CIED) infection.
  
  
  BACKGROUND
  CIED infection is sometimes challenging to diagnose. Because extraction is associated with significant morbidity/mortality, new imaging modalities to confirm the infection and its dissemination would be of clinical value.
  
  
  METHODS
  Three groups were compared. In Group A, 42 patients with suspected CIED infection underwent (18)F-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).
  
  
  CONCLUSIONS
  PET/CT is useful in differentiating between CIED infection and recent post-implant changes. It may guide appropriate therapy.
authors.affiliation: Department of Medicine, Division of Cardiology, Institut universitaire de cardiologie et pneumologie de Québec, 2725 chemin Sainte-Foy, Québec City, Quebec, Canada. jean-francois.sarrazin@criucpq.ulaval.ca
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Sarrazin
authors.forename: François
authors.initials: F
authors.lastname: Philippon
authors.forename: Michel
authors.initials: M
authors.lastname: Tessier
authors.forename: Jean
authors.initials: J
authors.lastname: Guimond
authors.forename: Franck
authors.initials: F
authors.lastname: Molin
authors.forename: Jean
authors.initials: J
authors.lastname: Champagne
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
authors.forename: Louis
authors.initials: L
authors.lastname: Blier
authors.forename: Maxime
authors.initials: M
authors.lastname: Nadeau
authors.forename: Lyne
authors.initials: L
authors.lastname: Charbonneau
authors.forename: Mikaël
authors.initials: M
authors.lastname: Trottier
authors.forename: Gilles
authors.initials: G
authors.lastname: O'Hara
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy; D053821:Cardiovascular Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D017147:Defibrillators, Implantable / Q000382:microbiology*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D009205:Myocarditis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D011792:Quebec / Q000453:epidemiology; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18