title: Early diagnosis of cardiac implantable electronic device generator pocket infection using ¹⁸F-FDG-PET/CT.
abstract: OBJECTIVE
  To examine the utility of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the early diagnosis of cardiac implantable electronic device (CIED) generator pocket infection.
  
  
  RESULTS
  A total of 86 patients with CIEDs were evaluated with (18)F-FDG PET/CT imaging: 46 with suspected generator pocket infection and 40 without any history of infection. (18)F-FDG activity in the region of the generator pocket was expressed as a semi-quantitative ratio (SQR)-defined as the maximum count rate around the CIED divided by the mean count rate between normal right and left lung parenchyma. All patients underwent standard clinical management, independent of the PET/CT result. Patients with suspected generator pocket infection that required CIED extraction (n = 32) had significantly higher (18)F-FDG activity compared with those that did not (n = 14), and compared with controls (n = 40) [SQR: 4.80 (3.18-7.05) vs. 1.40 (0.88-1.73) vs. 1.10 (0.98-1.40), respectively; P < 0.001]. On receiver operator characteristic analysis, SQR had a high diagnostic accuracy (area under curve = 0.98) for the early identification of patients with confirmed infection (i.e. those ultimately needing extraction)-with an optimal SQR cut-off value of >2.0 (sensitivity = 97%; specificity = 98%).
  
  
  CONCLUSIONS
  This study highlights the potential benefits of evaluating patients with suspected CIED generator pocket infection using (18)F-FDG PET/CT. In this study, (18)F-FDG PET/CT had a high diagnostic accuracy in the early diagnosis of CIED generator pocket infection, even where initial clinical signs were underwhelming.
authors: Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK foziaahmed@me.com.
authors: Fozia Zahir
authors: FZ
authors: Ahmed
authors: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Jacqueline
authors: J
authors: James
authors: Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Colin
authors: C
authors: Cunnington
authors: Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Manish
authors: M
authors: Motwani
authors: Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK Department of Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK.
authors: Catherine
authors: C
authors: Fullwood
authors: Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Jacquelyn
authors: J
authors: Hooper
authors: Department of Microbiology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Phillipa
authors: P
authors: Burns
authors: Department of Microbiology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Ahmed
authors: A
authors: Qamruddin
authors: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Ghada
authors: G
authors: Al-Bahrani
authors: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Ian
authors: I
authors: Armstrong
authors: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Deborah
authors: D
authors: Tout
authors: Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Bernard
authors: B
authors: Clarke
authors: Department of Microbiology, Leeds Teaching Hospitals NHS Trust, and University of Leeds, Leeds, UK.
authors: Jonathan A T
authors: JA
authors: Sandoe
authors: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Parthiban
authors: P
authors: Arumugam
authors: Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Mamas A
authors: MA
authors: Mamas
authors: Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Amir M
authors: AM
authors: Zaidi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D042241:Early Diagnosis; D004452:Echocardiography; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000601:surgery; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; Generator pocket infection; Imaging and diagnostics; Infection; Nuclear cardiology; Pacemakers
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