Document Detail


Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections.
MedLine Citation:
PMID:  22538331     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study evaluated the usefulness of fluorodesoxyglucose marked by fluorine-18 ((18)F-FDG) positron emission tomography (PET) and computed tomography (CT) in patients with suspected cardiovascular implantable electronic device (CIED) infection.
BACKGROUND: CIED infection is sometimes challenging to diagnose. Because extraction is associated with significant morbidity/mortality, new imaging modalities to confirm the infection and its dissemination would be of clinical value.
METHODS: Three groups were compared. In Group A, 42 patients with suspected CIED infection underwent (18)F-FDG PET/CT. Positive PET/CT was defined as abnormal uptake along cardiac devices. Group B included 12 patients without infection who underwent PET/CT 4 to 8 weeks post-implant. Group C included 12 patients implanted for >6 months without infection who underwent PET/CT for another indication. Semi-quantitative ratio (SQR) was obtained from the ratio between maximal uptake and lung parenchyma uptake.
RESULTS: In Group A, 32 of 42 patients with suspected CIED infection had positive PET/CT. Twenty-four patients with positive PET/CT underwent extraction with excellent correlation. In 7 patients with positive PET/CT, 6 were treated as superficial infection with clinical resolution. One patient with positive PET/CT but negative leukocyte scan was considered false positive due to Dacron pouch. Ten patients with negative-PET/CT were treated with antibiotics and none has relapsed at 12.9 ± 1.9 months. In Group B, patients had mild uptake seen at the level of the connector. There was no abnormal uptake in Group C patients. Median SQR was significantly higher in Group A (A = 2.02 vs. B = 1.08 vs. C = 0.57; p < 0.001).
CONCLUSIONS: PET/CT is useful in differentiating between CIED infection and recent post-implant changes. It may guide appropriate therapy.
Authors:
Jean-François Sarrazin; François Philippon; Michel Tessier; Jean Guimond; Franck Molin; Jean Champagne; Isabelle Nault; Louis Blier; Maxime Nadeau; Lyne Charbonneau; Mikaël Trottier; Gilles O'Hara
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  59     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-27     Completed Date:  2012-07-10     Revised Date:  2013-01-07    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1616-25     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Medicine, Division of Cardiology, Institut universitaire de cardiologie et pneumologie de Québec, 2725 chemin Sainte-Foy, Québec City, Quebec, Canada. jean-francois.sarrazin@criucpq.ulaval.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Arrhythmias, Cardiac / therapy
Cardiovascular Infections / diagnosis*,  epidemiology,  etiology
Defibrillators, Implantable / microbiology*
Diagnosis, Differential
Female
Fluorodeoxyglucose F18 / diagnostic use*
Follow-Up Studies
Humans
Male
Middle Aged
Morbidity / trends
Myocarditis / diagnosis*,  epidemiology,  etiology
Positron-Emission Tomography and Computed Tomography / utilization*
Prospective Studies
Prosthesis-Related Infections / diagnosis*
Quebec / epidemiology
Radiopharmaceuticals / diagnostic use
Reproducibility of Results
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 63503-12-8/Fluorodeoxyglucose F18
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2012 Nov 20;60(21):2259-60; author reply 2260   [PMID:  23153852 ]
J Am Coll Cardiol. 2012 May 1;59(18):1626-8   [PMID:  22538332 ]
J Am Coll Cardiol. 2012 Oct 9;60(15):1436-7; author reply 1437   [PMID:  23036634 ]
J Am Coll Cardiol. 2012 Oct 9;60(15):1435-6; author reply 1437   [PMID:  23036633 ]

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