title: Contributory Role of Fluorine 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnosis and Clinical Management of Infections in Patients Supported With a Continuous-Flow Left Ventricular Assist Device.
abstract: BACKGROUND
  The current study sought to demonstrate the advantages offered by fluorine 18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) in patients supported with continuous-flow left ventricular assist devices (CF-LVADs) in detecting infection and the consequent effect on clinical decisions.
  
  
  METHODS
  Between April 2009 and September 2013, 40 PET examinations were performed in 31 patients (78.1% men; mean age, 51.0 ± 14.9 years) supported with a CF-LVAD. In group A (19 examinations in 14 patients), PET/CT was performed to detect infectious focus in patients without external signs of driveline involvement but with at least two of the following infection signs: recurrent fever, positive blood culture, or elevated infectious indicators. In group B (21 examinations in 17 patients), PET/CT aimed to assess the internal extension of infection in patients with external signs of driveline infection.
  
  
  RESULTS
  In 50% of the cases of the patients in group A, abnormal (18)F-FDG uptake (9 patients) was related to VAD components. Matching the results with the final diagnosis, we reported 9 true-positive, 8 true-negative, no false-negative, and 2 false-positive findings. New information unrelated to VAD was found in 9 patients (50%): pneumonia in 3, colon diverticulitis in 3, sternal dehiscence in 1, paravertebral abscess in 1, and erysipelas in 1. In group B, superficial abnormal (18)F-FDG uptake was found at the piercing site of the driveline in 2 patients, deeper extension of infection along the driveline in 10, initial involvement of the pump housing in 2, and full involvement of the device in 4. These findings contributed to changing the clinical management in 84.2% of group A patients and in 85.7% of group B patients: 16 patients were scheduled for urgent transplantation, 2 underwent surgical revision of the driveline, 7 required prolonged antibiotic therapy, and 3 underwent colonoscopy.
  
  
  CONCLUSIONS
  This single-center experience highlights the diagnostic value of PET/CT in detecting the localization and internal extension of infection to internal VAD components. Moreover, this information notably influences the therapeutic management.
authors.affiliation: Department of Cardiac Surgery, University Hospital Münster, Münster, Germany. Electronic address: am.dellaquila@gmail.com.
authors.forename: Angelo Maria
authors.initials: AM
authors.lastname: Dell'Aquila
authors.affiliation: Cliniques Universitaires Saint-Luc, Universite' Catholique du Louvain, Bruxelles, Belgium.
authors.forename: Stefano
authors.initials: S
authors.lastname: Mastrobuoni
authors.affiliation: Department of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Alles
authors.affiliation: Department of Nuclear Medicine, University Hospital, Münster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wenning
authors.affiliation: Department of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Welp
authors.initials: W
authors.lastname: Henryk
authors.affiliation: Department of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Stefan Rudolf Bertram
authors.initials: SR
authors.lastname: Schneider
authors.affiliation: Department of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Deschka
authors.affiliation: Department of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Jürgen R
authors.initials: JR
authors.lastname: Sindermann
authors.affiliation: Department of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Mirela
authors.initials: M
authors.lastname: Scherer
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020878:Device Removal; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000628:therapy; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18