Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2023 May 31;24(6):819-828. doi: 10.1093/ehjci/jeac260.
Left ventricular assist devices (LVADs) improve quality of life and survival in patients with advanced heart failure, but device-related infections (DRIs) remain cumbersome. We evaluated the diagnostic capability of [18F]FDG PET/CT, factors affecting its accuracy, and the additive value of semi-quantitative analysis for the diagnosis of DRI.
LVAD recipients undergoing [18F]FDG PET/CT between 2012 and 2020 for suspected DRI were retrospectively included. [18F]FDG PET/CT was performed and evaluated in accordance with EANM guidelines. The final diagnosis of DRI, based on multidisciplinary consensus and findings during surgery, whenever performed, was used as the reference for diagnosis. 41 patients were evaluated for 59 episodes of suspected DRI. The clinical evaluation established driveline infection in 32 (55%) episodes, central device infection in 6 (11%), and combined infection in 2 (4%). Visual analysis of [18F]FDG PET/CT achieved a sensitivity and specificity for driveline infections of 0.79 and 0.71, respectively, whereas semi-quantitative analysis achieved a sensitivity and specificity of 0.94 and 0.83, respectively. For central device component infection, visual analysis of [18F]FDG PET/CT achieved a sensitivity and specificity of 0.75 and 0.60, respectively. Semi-quantitative analysis using SUVratio achieved a sensitivity and specificity of 1.0 and 0.8, respectively. The increase of specificity for central component infection was statistically significant (P = 0.05).
[18F]FDG PET/CT reliably predicts the presence of DRI in LVAD recipients. Semi-quantitative analysis may increase the specificity of [18F]FDG PET/CT for the analysis of central device component infection and should be considered in equivocal cases after visual analysis.
左心室辅助装置（LVAD）可改善晚期心力衰竭患者的生活质量和生存率，但与装置相关的感染（DRI）仍然很麻烦。我们评估了 [18F]FDG PET/CT 的诊断能力、影响其准确性的因素，以及半定量分析对诊断 DRI 的附加价值。
回顾性纳入 2012 年至 2020 年间因疑似 DRI 而接受 [18F]FDG PET/CT 的 LVAD 受者。[18F]FDG PET/CT 按照 EANM 指南进行，并进行了评估。根据多学科共识和手术时的发现，最终诊断为 DRI，并将其作为诊断的参考。41 例患者中有 59 例疑似 DRI。临床评估确定 32 例（55%）为导线感染，6 例（11%）为中央装置感染，2 例（4%）为合并感染。[18F]FDG PET/CT 的视觉分析对导线感染的敏感性和特异性分别为 0.79 和 0.71，而半定量分析的敏感性和特异性分别为 0.94 和 0.83。对于中央装置部件感染，[18F]FDG PET/CT 的视觉分析敏感性和特异性分别为 0.75 和 0.60。使用 SUVratio 的半定量分析的敏感性和特异性分别为 1.0 和 0.8。中央组件感染特异性的增加具有统计学意义（P=0.05）。
[18F]FDG PET/CT 可靠地预测 LVAD 受者中 DRI 的存在。半定量分析可能会提高 [18F]FDG PET/CT 对中央装置部件感染分析的特异性，并且在视觉分析后应考虑在可疑病例中使用。
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