title: The performance of quantitation methods in the evaluation of cardiac implantable electronic device (CIED) infection: A technical review.
abstract: Quantitative assessment of [18F]-FDG PET/CT images has been shown to be useful in the diagnosis of cardiac implantable electronic device (CIED) infection. This study aimed to compare the accuracy of various quantitative methods, using the same patient cohort and to assess the utility of dual time point imaging.
  
  
  
  The study comprised a retrospective review of 80 [18F]-FDG PET/CT studies. Of these, 41 were oncological patients with an asymptomatic CIED in situ (Group 1), and 39 were studies performed in patients with symptomatic devices. Of these, 14 were subsequently deemed on follow-up to be non-infected (Group 2), and 25 confirmed as infected post-device extraction (Group 3). Ratios of maximal uptake around the CIED in both the attenuation corrected and non-attenuation corrected images were calculated to regions of normal physiological uptake, along with the maximal standardized uptake value (SUVmax) alone. Receiver operating characteristic analysis was performed for all methods at both time points. Measurement reliability was assessed using the intraclass correlation coefficient (ICC).
  
  
  
  Using Group 1 as a reference, all methods gave an area under the curve (AUC) greater than 0.93. Using Group 2 as reference, the accuracy varied greatly, with AUC values ranging from 0.71 to 0.97. The hepatic blood pool (HBP) ratio gave the highest AUC values. The calculated ICC values for each method showed the SUVmaxand HBP measurement to have the greatest reliability, with values of 1.0 and 0.97, respectively.
  
  
  
  Quantitation of [18F] FDG uptake was found to have a high degree of accuracy in confirming the diagnosis of CIED infection. Normalization to HBP uptake was found to give the greatest AUC and demonstrated excellent reliability. Inconsistencies from published data indicate that individual imaging centers should only use published data for guidance.
authors.affiliation: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom. matthew.memmott@cmft.nhs.uk.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Memmott
authors.affiliation: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: James
authors.affiliation: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Armstrong
authors.affiliation: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom.
authors.forename: Deborah
authors.initials: D
authors.lastname: Tout
authors.affiliation: Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Fozia
authors.initials: F
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism*; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: PET/CT imaging; fluorodeoxyglucose (FDG); inflammation