Department of Medicine, Division of Cardiology, Institut universitaire de cardiologie et pneumologie de Québec, 2725 chemin Sainte-Foy, Québec City, Quebec, Canada.
J Am Coll Cardiol. 2012 May 1;59(18):1616-25. doi: 10.1016/j.jacc.2011.11.059.
This study evaluated the usefulness of fluorodesoxyglucose marked by fluorine-18 ((18)F-FDG) positron emission tomography (PET) and computed tomography (CT) in patients with suspected cardiovascular implantable electronic device (CIED) infection.
CIED infection is sometimes challenging to diagnose. Because extraction is associated with significant morbidity/mortality, new imaging modalities to confirm the infection and its dissemination would be of clinical value.
Three groups were compared. In Group A, 42 patients with suspected CIED infection underwent (18)F-FDG PET/CT. Positive PET/CT was defined as abnormal uptake along cardiac devices. Group B included 12 patients without infection who underwent PET/CT 4 to 8 weeks post-implant. Group C included 12 patients implanted for >6 months without infection who underwent PET/CT for another indication. Semi-quantitative ratio (SQR) was obtained from the ratio between maximal uptake and lung parenchyma uptake.
In Group A, 32 of 42 patients with suspected CIED infection had positive PET/CT. Twenty-four patients with positive PET/CT underwent extraction with excellent correlation. In 7 patients with positive PET/CT, 6 were treated as superficial infection with clinical resolution. One patient with positive PET/CT but negative leukocyte scan was considered false positive due to Dacron pouch. Ten patients with negative-PET/CT were treated with antibiotics and none has relapsed at 12.9 ± 1.9 months. In Group B, patients had mild uptake seen at the level of the connector. There was no abnormal uptake in Group C patients. Median SQR was significantly higher in Group A (A = 2.02 vs. B = 1.08 vs. C = 0.57; p < 0.001).
PET/CT is useful in differentiating between CIED infection and recent post-implant changes. It may guide appropriate therapy.
本研究评估了氟代脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）和计算机断层扫描（CT）在疑似心血管植入式电子设备（CIED）感染患者中的应用价值。
CIED 感染的诊断有时具有挑战性。由于取出装置会导致严重的发病率/死亡率，因此新的成像方式来确认感染及其传播将具有临床价值。
比较了三组患者。A 组 42 例疑似 CIED 感染患者行 18F-FDG PET/CT 检查。阳性 PET/CT 定义为心脏装置附近摄取异常。B 组 12 例无感染患者于植入后 4-8 周行 PET/CT 检查。C 组 12 例植入超过 6 个月且无感染患者因其他指征行 PET/CT 检查。半定量比值（SQR）通过摄取最大值与肺实质摄取值的比值获得。
A 组中，42 例疑似 CIED 感染患者中有 32 例 PET/CT 阳性。24 例 PET/CT 阳性患者行取出术，结果与 PET/CT 具有良好的相关性。7 例 PET/CT 阳性患者中，6 例因感染浅表而接受治疗，痊愈。1 例 PET/CT 阳性但白细胞扫描阴性患者因涤纶套而被认为是假阳性。10 例 PET/CT 阴性患者行抗生素治疗，12.9±1.9 个月时无复发。B 组患者连接器水平可见轻度摄取，C 组患者无异常摄取。A 组（A = 2.02）的 SQR 中位数显著高于 B 组（B = 1.08）和 C 组（C = 0.57；p < 0.001）。
PET/CT 有助于区分 CIED 感染和近期植入后变化。它可能指导适当的治疗。
