title: Positron Emission Tomography and Single-Photon Emission Computed Tomography Imaging in the Diagnosis of Cardiac Implantable Electronic Device Infection: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  The use of cardiac implantable electronic devices (CIED) is increasing, and their associated infections result in significant morbidity and mortality. The introduction of better cardiac imaging techniques could be useful for diagnosing this condition and guiding therapy. Our objective was to systematically assess the diagnostic accuracy of Fluor-18-fluorodeoxyglucose positron emission tomography and computed tomography, labeled leukocyte scintigraphy (LS), and Gallium-67 citrate scintigraphy for the diagnosis of CIED infection.
  
  
  RESULTS
  A systematic review of the literature and meta-analysis on the use of all 3 modalities in CIED infection were conducted. Pooled sensitivity, specificity, and summary receiver operating characteristic curves of each imaging modalities were determined. The literature search identified 2493 articles. A total of 13 articles (11 studies for18F-FDG PET-CT and 2 for LS), met the inclusion criteria. No studies for67Ga citrate scintigraphy met the inclusion criteria. The pooled sensitivity of18F-FDG PET-CT for the diagnosis of CIED infection was 87% (95% CI, 82%-91%) and pooled specificity was 94% (95% CI, 88%-98%). The summary receiver operating characteristic curve analysis demonstrated good overall accuracy, with an area under the curve of 0.935. There were insufficient data to do a meta-analysis for LS, but both studies reported sensitivity above 90% and specificity of 100%.
  
  
  CONCLUSIONS
  Both18F-FDG PET-CT and LS yield high sensitivity, specificity, and accuracy, and thus seem to be useful for the diagnosis of CIED infection, based on robust data for18F-FDG PET-CT but limited data for LS. When available,18F-FDG PET-CT may be preferred.
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Juneau
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Mohammad
authors.initials: M
authors.lastname: Golfam
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Samir
authors.initials: S
authors.lastname: Hazra
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Lionel S
authors.initials: LS
authors.lastname: Zuckier
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Shady
authors.initials: S
authors.lastname: Garas
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Calum
authors.initials: C
authors.lastname: Redpath
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Jordan
authors.initials: J
authors.lastname: Bernick
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Eugene
authors.initials: E
authors.lastname: Leung
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Sharon
authors.initials: S
authors.lastname: Chih
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: George
authors.initials: G
authors.lastname: Wells
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
authors.forename: Rob S B
authors.initials: RS
authors.lastname: Beanlands
authors.affiliation: From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.). bchow@ottawaheart.ca.
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016009:Chi-Square Distribution; D002951:Citrates / Q000008:administration & dosage; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage; D005708:Gallium / Q000008:administration & dosage; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000382:microbiology; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002951:Citrates; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005708:Gallium; C103850:gallium citrate
keywords: Fluor-18-fluorodeoxyglucose; gallium; leukocyte; positron emission tomography