18F-FDG positron emission tomography/computed tomography of cardiac implantable electronic device infections

Abstract

<p><i>Background.</i> The diagnosis of cardiac implantable electronic device (CIED) infection is challenging because of its variable presentations. We studied the value of 2-[¹⁸F]fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) in the detection of CIED infection.</p><p><i>Methods and results.</i> Thirty patients with suspected CIED infection underwent ¹⁸F-FDG-PET/CT. The control group was ten patients with asymptomatic CIED who underwent cancer related ¹⁸F-FDG-PET/CT. ¹⁸F-FDG-PET/CT was evaluated visually, semiquantitatively as maximum standardized uptake value (SUV_max) and target-to-background ratio (TBR). Final diagnosis of CIED infection was based on clinical and bacteriological data. ¹⁸F-FDG-PET/CT was visually positive in all 9 patients with recent ( ≤ 8 weeks) implantation of CIED, but only 4 had confirmed CIED infection. ¹⁸F-FDG-PET/CT was true positive in 9 out of 21 cases with remote implantation of CIED and false positive in 3 (14.3%) cases. ¹⁸F-FDG-PET/CT was also false positive in 3 (30%) cases of control group. The SUV_max of the pocket area was significantly higher in patients with CIED infection than in the control group (4.8 ± 2.4 vs 2.0 ± .8, <i>P</i> < .001). By using the cut-off value of TBR ≥ 1.8, sensitivity of 18F-FDG-PET/CT for the diagnosis of CIED infection in patients with remote implantation was 90% and specificity 73%, PPV 75%, and NPV 89% </p><p><i>Conclusions. </i>¹⁸F-FDG-PET/CT is a sensitive but nonspecific method in the diagnosis of CIED infection.</p>