Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain.
Servicio de Medicina Nuclear, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Spain.
Rev Esp Cardiol (Engl Ed). 2023 Dec;76(12):970-979. doi: 10.1016/j.rec.2023.04.001. Epub 2023 Apr 6.
The role of [18F]FDG-PET/CT in cardiac implantable electronic device (CIED) infections requires better evaluation, especially in the diagnosis of systemic infections. We aimed to determine the following: a) the diagnostic accuracy of [18F]FDG-PET/CT in each CIED topographical region, b) the added value of [18F]FDG-PET/CT over transesophageal echocardiography (TEE) in diagnosing systemic infections, c) spleen and bone marrow uptake in differentiating isolated local infections from systemic infections, and d) the potential application of [18F]FDG-PET/CT in follow-up.
Retrospective single-center study including 54 cases and 54 controls from 2014 to 2021. The Primary endpoint was the diagnostic yield of [18F]FDG-PET/CT in each topographical CIED region. Secondary analyses described the performance of [18F]FDG-PET/CT compared with that of TEE in systemic infections, bone marrow and spleen uptake in systemic and isolated local infections, and the potential application of [18F]FDG-PET/CT in guiding cessation of chronic antibiotic suppression when completed device removal is not performed.
We analyzed 13 (24%) isolated local infections and 41 (76%) systemic infections. Overall, the specificity of [18F]FDG-PET/CT was 100% and sensitivity 85% (79% pocket, 57% subcutaneous lead, 22% endovascular lead, 10% intracardiac lead). When combined with TEE, [18F]FDG-PET/CT increased definite diagnosis o fsystemic infections from 34% to 56% (P=.04). Systemic infections with bacteremia showed higher spleen (P=.05) and bone marrow metabolism (P=.04) than local infections. Thirteen patients without complete device removal underwent a follow-up [18F]FDG-PET/CT, with no relapses after discontinuation of chronic antibiotic suppression in 6 cases with negative follow-up [18F]FDG-PET/CT.
The sensitivity of [18F]FDG-PET/CT for evaluating CIED infections was high in local infections but much lower in systemic infections. However, accuracy increased when [18F]FDG-PET/CT was combined with TEE in endovascular lead bacteremic infection. Spleen and bone marrow hypermetabolism could differentiate bacteremic systemic infection from local infection. Although further prospective studies are needed, follow-up [18F]FDG-PET/CT could play a potential role in the management of chronic antibiotic suppression therapy when complete device removal is unachievable.
[18F]FDG-PET/CT 在心脏植入式电子设备 (CIED) 感染中的作用需要更好的评估，尤其是在诊断全身感染方面。我们旨在确定以下几点：a）[18F]FDG-PET/CT 在每个 CIED 解剖区域的诊断准确性，b）[18F]FDG-PET/CT 在诊断全身感染方面相对于经食管超声心动图 (TEE) 的附加价值，c）脾脏和骨髓摄取在区分孤立性局部感染与全身感染方面的作用，以及 d）[18F]FDG-PET/CT 在随访中的潜在应用。
回顾性单中心研究，纳入 2014 年至 2021 年的 54 例病例和 54 例对照。主要终点是 [18F]FDG-PET/CT 在每个解剖 CIED 区域的诊断效果。次要分析描述了 [18F]FDG-PET/CT 与 TEE 在全身感染中的性能比较、全身和孤立性局部感染中脾脏和骨髓摄取情况，以及在无法完全移除设备时，[18F]FDG-PET/CT 在指导停止慢性抗生素抑制方面的潜在应用。
我们分析了 13 例（24%）孤立性局部感染和 41 例（76%）全身感染。总体而言，[18F]FDG-PET/CT 的特异性为 100%，敏感性为 85%（口袋 79%、皮下导线 57%、血管内导线 22%、心内导线 10%）。当与 TEE 结合使用时，[18F]FDG-PET/CT 将全身感染的明确诊断率从 34%提高到 56%（P=.04）。有菌血症的全身感染患者的脾脏（P=.05）和骨髓代谢（P=.04）高于局部感染。13 例未完全移除设备的患者进行了随访 [18F]FDG-PET/CT，在 6 例阴性随访 [18F]FDG-PET/CT 的患者中，停止慢性抗生素抑制后无复发。
[18F]FDG-PET/CT 评估 CIED 感染的局部感染的敏感性较高，但全身感染的敏感性较低。然而，当 [18F]FDG-PET/CT 与血管内导线菌血症感染的 TEE 联合使用时，准确性会提高。脾脏和骨髓代谢亢进可区分菌血症性全身感染与局部感染。尽管需要进一步的前瞻性研究，但无法完全移除设备时，随访 [18F]FDG-PET/CT 可能在慢性抗生素抑制治疗的管理中发挥潜在作用。
