title: Diagnostic yield of FDG positron-emission tomography/computed tomography in patients with CEID infection: a pilot study.
abstract: OBJECTIVE
  Whole body imaging with (18)F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) has proven useful in various infectious diseases. The purpose of this pilot study was to assess the diagnostic yield of FDG PET/CT in patients with cardiac implantable electronic device (CIED) infection.
  
  
  RESULTS
  A total of 21 patients with CIED infection were prospectively included. Diagnosis of CIED infection was made in accordance with current criteria. It was classified in three categories, i.e. superficial skin infection, pocket site infection, or cardiac device-related infective endocarditis (CDRIE). All patients underwent FDG PET/CT. Scans were interpreted blindly, i.e. without prior knowledge of diagnosis, by experienced nuclear medicine physicians. The accuracy of FDG PET/CT was assessed for each diagnostic category. Findings demonstrated superficial skin infection in 1 patient, pocket site infection in 15, and CDRIE in 13 (definite: 7; possible: 6). In patients with pocket site infection, the sensitivity and specificity of FDG PET/CT were 86.7% [59.5-98.3, 95% confidence interval (CI)] and 100% [42.1-100, 95% CI]. The only patient with superficial skin infection was accurately identified by FDG PET/CT. The sensitivity and specificity of FDG PET/CT in patients with CDRIE were 30.8% [9.1-61.4, 95% CI] and 62.5% [24.5-91.5, 95% CI]. Most false-negative results occurred in patients who had undergone previous antimicrobial treatment.
  
  
  CONCLUSIONS
  This study indicates that FDG PET/CT is highly accurate for the diagnosis of skin and pocket CIED infection but low for infective endocarditis. This suggests that the reliability of FDG PET/CT findings in management decision making varies according to the type of CIED infection.
authors.affiliation: Department of Cardiology,  La Timone Hospital, CHU La Timone, 264, Rue Saint Pierre, 13005 Marseille,  France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cautela
authors.forename: Stephane
authors.initials: S
authors.lastname: Alessandrini
authors.forename: Serge
authors.initials: S
authors.lastname: Cammilleri
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
authors.forename: Herve
authors.initials: H
authors.lastname: Richet
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Casalta
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Olivier
authors.initials: O
authors.lastname: Mundler
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004696:Endocarditis / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods* / Q000592:standards*; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging / Q000379:methods / Q000592:standards
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18