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Eur Heart J Cardiovasc Imaging. 2015 May;16(5):521-30. doi: 10.1093/ehjci/jeu295. Epub 2015 Feb 3.

Early diagnosis of cardiac implantable electronic device generator pocket infection using ¹⁸F-FDG-PET/CT.

Author information

1
Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK foziaahmed@me.com.
2
Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
3
Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
4
Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK Department of Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK.
5
Department of Microbiology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
6
Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
7
Department of Microbiology, Leeds Teaching Hospitals NHS Trust, and University of Leeds, Leeds, UK.

Abstract

AIMS:

To examine the utility of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the early diagnosis of cardiac implantable electronic device (CIED) generator pocket infection.

METHODS AND RESULTS:

A total of 86 patients with CIEDs were evaluated with (18)F-FDG PET/CT imaging: 46 with suspected generator pocket infection and 40 without any history of infection. (18)F-FDG activity in the region of the generator pocket was expressed as a semi-quantitative ratio (SQR)-defined as the maximum count rate around the CIED divided by the mean count rate between normal right and left lung parenchyma. All patients underwent standard clinical management, independent of the PET/CT result. Patients with suspected generator pocket infection that required CIED extraction (n = 32) had significantly higher (18)F-FDG activity compared with those that did not (n = 14), and compared with controls (n = 40) [SQR: 4.80 (3.18-7.05) vs. 1.40 (0.88-1.73) vs. 1.10 (0.98-1.40), respectively; P < 0.001]. On receiver operator characteristic analysis, SQR had a high diagnostic accuracy (area under curve = 0.98) for the early identification of patients with confirmed infection (i.e. those ultimately needing extraction)-with an optimal SQR cut-off value of >2.0 (sensitivity = 97%; specificity = 98%).

CONCLUSION:

This study highlights the potential benefits of evaluating patients with suspected CIED generator pocket infection using (18)F-FDG PET/CT. In this study, (18)F-FDG PET/CT had a high diagnostic accuracy in the early diagnosis of CIED generator pocket infection, even where initial clinical signs were underwhelming.

KEYWORDS:

18F-FDG PET/CT; Generator pocket infection; Imaging and diagnostics; Infection; Nuclear cardiology; Pacemakers

PMID:
25651856
PMCID:
PMC4407104
DOI:
10.1093/ehjci/jeu295
[Indexed for MEDLINE]
Free PMC Article

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