F-FDG PET/CT-imaging of left ventricular assist device infection: a retrospective quantitative intrapatient analysis.

BACKGROUND

Despite the use of F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT), diagnosis of a driveline infection in ventricular assist device (LVAD) recipients remains challenging. Our aim was to evaluate the potential of a baseline F-FDG PET/CT (prior to an infection) for the diagnosis of an LVAD-related infection.

METHODS

We retrospectively selected all LVAD recipients who had undergone two consecutive whole-body F-FDG PET/CT examinations between January 2010 and December 2016. PET/CT was analyzed qualitatively (uptake pattern) and semi-quantitatively (SUV and ∆SUV). SUV was measured and compared in five distinctive volumes of interest along the LVAD driveline. An SUV threshold was calculated. Final diagnosis was made by clinical examination, microbiological parameters, and molecular imaging.

RESULTS

Thirty patients were enrolled (mean age 54 ± 12 years; 26 male). Mean difference in SUV for all five positions between the first and the second PET/CT along the driveline was significantly higher in patients with an LVAD-related infection (mean ∆SUV = 4.38 ± 1.44) compared to those without a driveline infection (mean ∆SUV = 0.03 ± 0.43), P < 0.05. Applying ROC analysis, an SUV threshold of 3.88 resulted in a sensitivity and specificity of 100%, respectively. There were three distinctive uptake patterns in patients with a driveline infection.

CONCLUSION

PET/CT diagnosis in the context of an LVAD-related infection can be improved by comparison to a baseline examination using a distinctive SUV threshold.