title: Radiolabeled WBC scintigraphy in the diagnostic workup of patients with suspected device-related infections.
abstract: OBJECTIVE
  The aim of this study was to investigate the diagnostic performance of (99m)Tc-hexamethypropylene amine oxime labeled autologous white blood cell ((99m)Tc-HMPAO-WBC) scintigraphy in patients with suspected infections associated with cardiovascular implantable electronic devices (CIEDs).
  
  
  BACKGROUND
  Early, definite recognition of CIED-related infections combined with accurate localization and quantification of disease burden is a prerequisite for optimal treatment strategies.
  
  
  METHODS
  All 63 consecutive patients underwent clinical examination, blood chemistry, microbiology, and echography of the cardiac region/venous pathway of the device. Final diagnosis of infection was established in 32 of 63 patients and in 23 of 32 by microbiology.
  
  
  RESULTS
  Sensitivity of (99m)Tc-HMPAO-WBC single-photon emission computed tomography/computed tomography (SPECT/CT) was 94% for both detection and localization of CIED-associated infection. SPECT/CT imaging had a definite added diagnostic value over both planar and stand-alone SPECT. Pocket infection was often associated with lead(s) involvement; the intracardiac portion of the lead(s) more frequently exhibited (99m)Tc-HMPAO-WBC accumulation and presented the highest rate of complications, infectious endocarditis, and septic embolism. Two false negative cases and no false positive results were observed. None of the patients with negative (99m)Tc-HMPAO-WBC scintigraphy developed CIED-related infection during follow-up of 12 months. Echography of the cardiac region/venous pathway of the device had 90% specificity, but low sensitivity (81% when intracardiac lead[s] infection only was considered). The Duke criteria had 31% sensitivity for the definite category (100% specificity) and 81% for the definite and possible categories (77% specificity).
  
  
  CONCLUSIONS
  (99m)Tc-HMPAO-WBC scintigraphy enabled the confirmation of the presence of CIED-associated infection, definition of the extent of device involvement, and detection of associated complications. Moreover, (99m)Tc-HMPAO-WBC scintigraphy reliably excluded device-associated infection during a febrile episode and sepsis, with 95% negative predictive value.
authors.affiliation: Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy. Electronic address: p.erba@med.unipi.it.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Erba
authors.affiliation: Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Sollini
authors.affiliation: Division of Cardiology, University Hospital of Pisa, Pisa, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Conti
authors.affiliation: Division of Cardiology, University Hospital of Pisa, Pisa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandera
authors.affiliation: Division of Infectious Diseases, University Hospital of Pisa, Pisa, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tascini
authors.affiliation: Division of Cardiology, University Hospital of Pisa, Pisa, Italy.
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: De Tommasi
authors.affiliation: Division of Cardiology, University Hospital of Pisa, Pisa, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Zucchelli
authors.affiliation: Division of Infectious Diseases, University Hospital of Pisa, Pisa, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Doria
authors.affiliation: Division of Infectious Diseases, University Hospital of Pisa, Pisa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Menichetti
authors.affiliation: Division of Cardiology, University Hospital of Pisa, Pisa, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bongiorni
authors.affiliation: Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Lazzeri
authors.affiliation: Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Mariani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001431:Bacteriological Techniques; D001804:Blood Transfusion, Autologous; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005188:False Negative Reactions; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007558:Italy; D017708:Leukocyte Transfusion; D007962:Leukocytes / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000628:therapy; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D019690:Technetium Tc 99m Exametazime; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime
keywords: (18)F-labeled fluorodeoxyglucose positron emission tomography/computed tomography; (99m)Tc-HMPAO-WBC; (99m)Tc-HMPAO-WBCs; CIED; CT; SPECT; SPECT/CT; Technitium-99m–hexamethyl propylene amine oxime–labeled autologous white blood cell; [(18)F]FDG PET/CT; cardiac device infection; cardiovascular implantable electronic device; computed tomography; disease burden; single-photon emission computed tomography