title: Contribution of PET Imaging to the Diagnosis of Septic Embolism in Patients With Pacing Lead Endocarditis.
abstract: OBJECTIVE
  The aim of this study was to investigate the role of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scanning in identifying septic embolism in patients with lead endocarditis.
  
  
  BACKGROUND
  Lead endocarditis may be associated with septic embolism, in which case the administration mode, type, and duration of antibiotic therapy must be adapted. However, diagnosis can be challenging: magnetic resonance imaging (MRI) cannot be performed in the vast majority of patients with cardiac implantable electronic devices (CIEDs). FDG PET/CT scanning has been proposed as a diagnostic tool for suspected CIED infection.
  
  
  METHODS
  Thirty-five consecutive patients with lead endocarditis were prospectively studied. FDG PET/CT scanning was performed and analyzed blindly by experienced nuclear medicine physicians to assess for the presence of septic embolism 2 days before lead extraction.
  
  
  RESULTS
  FDG PET/CT scanning identified septic emboli in 10 patients (29%): 7 with spondylodiscitis, 2 with septic pulmonary emboli, and 1 with an infected vascular prosthesis. Among the 7 patients with occult spondylodiscitis, 4 were asymptomatic, and 3 had back pain with negative CT imaging, MRI being contraindicated due to non MRI-compatible CIEDs. Antimicrobial therapy was adapted (double antibiotic therapy with good bone penetration) and prolonged. Among other important ancillary findings, 3 patients presented focal FDG uptake in the colon (1 adenocarcinoma, and 2 resected polyps) and 2 in the esophagus (both cases confirmed as neoplasia).
  
  
  CONCLUSIONS
  This study emphasizes the potential utility of FDG PET/CT scanning as a diagnostic tool for septic emboli in patients with pacing lead endocarditis. This promising diagnostic tool may be integrated in the diagnostic algorithm of patients with lead endocarditis because diagnosis of septic embolisms has a direct and significant impact on the therapeutic care pathway.
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France. Electronic address: sana.amraoui@hotmail.com.
authors.forename: Sana
authors.initials: S
authors.lastname: Amraoui
authors.affiliation: CHU de Bordeaux, Service de Médecine Nucléaire et CIC 1401, Bordeaux, France.
authors.forename: Ghoufrane
authors.initials: G
authors.lastname: Tlili
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berte
authors.affiliation: CHU de Bordeaux, Service de Médecine Nucléaire et CIC 1401, Bordeaux, France.
authors.forename: Elif
authors.initials: E
authors.lastname: Hindié
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Rinaldi
authors.affiliation: CHU de Bordeaux, Department of Infectious and Tropical Diseases, Hôpital Pellegrin, Bordeaux, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Cazanave
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.affiliation: CHU de Bordeaux, Service de Médecine Nucléaire et CIC 1401, Bordeaux, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Bordenave
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004617:Embolism / Q000000981:diagnostic imaging* / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010865:Pilot Projects; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery; D019275:Radiopharmaceuticals; D018805:Sepsis / Q000000981:diagnostic imaging* / Q000382:microbiology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG PET/CT scanning; lead endocarditis; pacemaker infection; septic emboli; spondylodiscitis