Cardiovascular implantable electronic device infection: delayed vs standard FDG PET-CT imaging.
BACKGROUND
Positron emission tomography-computed tomography (PET-CT) with (18)F-fluorodeoxyglucose (FDG) has emerged as a rapidly evolving diagnostic tool for infectious diseases. However, the optimal imaging time in this clinical setting is not clear yet. The aim of this study is to investigate whether delayed (3 hours) FDG PET-CT could increase the diagnostic accuracy of this technique compared to standard (1 hour) imaging in the detection of septic foci involving the pocket and/or pacing leads in patients with suspected cardiovascular implantable electronic device (CIED) infection scheduled for device removal.


RESULTS
Twenty-seven patients underwent standard and delayed imaging. PET-CT results were compared to bacteriological cultures after CIED removal. Fifteen controls free of infection underwent PET-CT imaging as part of investigation of malignancy. The diagnostic accuracy of delayed imaging was significantly higher than 1-hour scan for lead infection (70% vs 51%, P = .024). No significant difference was found between standard and delayed diagnostic accuracy for pocket or device infection. Semi-quantitative analysis showed that mean pocket and lead target-to-background ratio were significantly higher on delayed compared to standard imaging (3.7 ± 1.9 vs 1.6 ± 1.1, P = .0002; 3.0 ± 1.3 vs 0.7 ± 1.0, P = .01).


CONCLUSIONS
Delayed FDG PET-CT imaging should be considered at least in patients with negative 1-hour scan and founded suspicion of pacing lead infection.
Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy, lucia.leccisotti@rm.unicatt.it.
Lucia
L
Leccisotti
Francesco
F
Perna
Mariaelena
M
Lago
Milena
M
Leo
Antonella
A
Stefanelli
Maria L
ML
Calcagni
Gemma
G
Pelargonio
Maria L
ML
Narducci
Gianluigi
G
Bencardino
Fulvio
F
Bellocci
Alessandro
A
Giordano
D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D049268:Positron-Emission Tomography / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18