Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy.
Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy.
JACC Cardiovasc Imaging. 2013 Oct;6(10):1075-1086. doi: 10.1016/j.jcmg.2013.08.001. Epub 2013 Sep 4.
OBJECTIVES: The aim of this study was to investigate the diagnostic performance of (99m)Tc-hexamethypropylene amine oxime labeled autologous white blood cell ((99m)Tc-HMPAO-WBC) scintigraphy in patients with suspected infections associated with cardiovascular implantable electronic devices (CIEDs). BACKGROUND: Early, definite recognition of CIED-related infections combined with accurate localization and quantification of disease burden is a prerequisite for optimal treatment strategies. METHODS: All 63 consecutive patients underwent clinical examination, blood chemistry, microbiology, and echography of the cardiac region/venous pathway of the device. Final diagnosis of infection was established in 32 of 63 patients and in 23 of 32 by microbiology. RESULTS: Sensitivity of (99m)Tc-HMPAO-WBC single-photon emission computed tomography/computed tomography (SPECT/CT) was 94% for both detection and localization of CIED-associated infection. SPECT/CT imaging had a definite added diagnostic value over both planar and stand-alone SPECT. Pocket infection was often associated with lead(s) involvement; the intracardiac portion of the lead(s) more frequently exhibited (99m)Tc-HMPAO-WBC accumulation and presented the highest rate of complications, infectious endocarditis, and septic embolism. Two false negative cases and no false positive results were observed. None of the patients with negative (99m)Tc-HMPAO-WBC scintigraphy developed CIED-related infection during follow-up of 12 months. Echography of the cardiac region/venous pathway of the device had 90% specificity, but low sensitivity (81% when intracardiac lead[s] infection only was considered). The Duke criteria had 31% sensitivity for the definite category (100% specificity) and 81% for the definite and possible categories (77% specificity). CONCLUSIONS: (99m)Tc-HMPAO-WBC scintigraphy enabled the confirmation of the presence of CIED-associated infection, definition of the extent of device involvement, and detection of associated complications. Moreover, (99m)Tc-HMPAO-WBC scintigraphy reliably excluded device-associated infection during a febrile episode and sepsis, with 95% negative predictive value.
目的：本研究旨在探讨（99m）Tc-六甲基丙撑胺肟标记自体白细胞（（99m）Tc-HMPAO-WBC）闪烁显像在疑似与心血管植入式电子设备（CIEDs）相关感染患者中的诊断性能。
背景：早期明确识别与 CIED 相关的感染，结合对疾病负担的准确定位和定量，是制定最佳治疗策略的前提。
方法：所有 63 例连续患者均接受临床检查、血液化学、微生物学和心脏区域/设备静脉途径的超声检查。32 例患者中的 23 例通过微生物学最终诊断为感染。
结果：（99m）Tc-HMPAO-WBC 单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）对 CIED 相关感染的检测和定位的敏感性均为 94%。SPECT/CT 成像比平面和独立 SPECT 具有明确的附加诊断价值。口袋感染常与导线受累有关；导线的心脏内部分更常显示（99m）Tc-HMPAO-WBC 积聚，并呈现最高的并发症发生率，感染性心内膜炎和感染性栓塞。观察到 2 例假阴性病例和无假阳性结果。在 12 个月的随访期间，未接受（99m）Tc-HMPAO-WBC 闪烁显像的患者未发生 CIED 相关感染。心脏区域/设备静脉途径的超声检查具有 90%的特异性，但敏感性较低（仅考虑心内导线感染时为 81%）。杜克标准对明确类别（100%特异性）的敏感性为 31%，对明确和可能类别（77%特异性）的敏感性为 81%。
结论：（99m）Tc-HMPAO-WBC 闪烁显像能够确认 CIED 相关感染的存在、确定设备受累的程度，并检测相关并发症。此外，（99m）Tc-HMPAO-WBC 闪烁显像在发热和脓毒症期间可靠地排除了与设备相关的感染，阴性预测值为 95%。
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