Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.).
Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.).
Circ Cardiovasc Imaging. 2019 Jul;12(7):e007188. doi: 10.1161/CIRCIMAGING.117.007188. Epub 2019 Jul 11.
Cardiac implantable electronic devices (CIEDs) chronic infection diagnosis is challenging because the clinical presentation is frequently misleading and echocardiography may be inconclusive. The aim of this study was to evaluate the diagnostic value of F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and radiolabeled white blood cells single photon emission CT/CT in a cohort of patients who underwent both scans for suspicion of CIED infection and inconclusive routine investigations.
Forty-eight consecutive patients with suspicion of CIED infection who underwent both F-fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT in a time span ≤30 days were retrospectively included. The final diagnosis of CIED infection by the endocarditis expert team was based on the modified Duke-Li classification at the end of follow-up. F-Fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT scans were independently analyzed blinded to the patients' medical record.
In the overall study population, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were respectively 80%, 91%, 80%, and 91% for F-fluorodeoxyglucose positron emission tomography/CT and 60%, 100%, 100%, and 85% for white blood cell single photon emission CT/CT. Addition of a positive nuclear imaging scan as a major criterion markedly improved the Duke-Li classification at admission. Semiquantitative parameters did not allow to discriminate between definite and rejected CIED infection. Prolonged antibiotic therapy before imaging tended to decrease the sensitivity for both techniques.
Nuclear imaging can improve the diagnostic performances of the Duke-Li score at admission in a selected population of patients with suspected CIED infection, particularly when the infection was initially graded as possible. Whenever possible, imaging should be performed before or early after antibiotic initiation.
心脏植入式电子设备（CIED）慢性感染的诊断具有挑战性，因为临床表现常常具有误导性，且超声心动图可能无法得出明确结论。本研究旨在评估氟-18 脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）和放射性标记白细胞单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）在一组因怀疑 CIED 感染而接受这两种扫描但常规检查结果不确定的患者中的诊断价值。
回顾性纳入 48 例因怀疑 CIED 感染而在 30 天内同时接受氟-18 脱氧葡萄糖正电子发射断层扫描/CT 和白细胞单光子发射计算机断层扫描/CT 的连续患者。最终诊断由感染性心内膜炎专家团队根据改良的 Duke-Li 分类在随访结束时确定。氟-18 脱氧葡萄糖正电子发射断层扫描/CT 和白细胞单光子发射计算机断层扫描/CT 扫描由独立的、对患者病历不知情的观察者进行分析。
在整个研究人群中，氟-18 脱氧葡萄糖正电子发射断层扫描/CT 的诊断敏感性、特异性、阳性预测值和阴性预测值分别为 80%、91%、80%和 91%，白细胞单光子发射计算机断层扫描/CT 的诊断敏感性、特异性、阳性预测值和阴性预测值分别为 60%、100%、100%和 85%。将阳性核成像扫描作为主要标准可显著提高入院时的 Duke-Li 分类。半定量参数无法区分明确的和被排除的 CIED 感染。在成像前接受延长的抗生素治疗往往会降低两种技术的敏感性。
核成像可以改善在疑似 CIED 感染的选定患者人群中入院时 Duke-Li 评分的诊断性能，特别是在最初将感染分类为可能时。只要有可能，应在开始抗生素治疗之前或早期进行成像。
