Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography for improving diagnosis of infection in patients on CF-LVAD: longing for more ‘insights’

Avramović, Nemanja; Mastrobuoni, Stefano; Motekallemi, Arash; Wisniewski, Konrad; Scherer, M.; Sindermann, Jürgen R.; Wenning, Christian

doi:10.1093/ehjci/jex158

Cited by 33 publications

(28 citation statements)

References 13 publications

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“…A careful evaluation of the aspects of the low-dose CT and non-attenuation corrected PET acquisitions should thus be performed when interpreting FDG-PET images in this clinical situation. Until now, only a limited number of studies [6][7][8][9] have evaluated the diagnostic performance of FDG-PET imaging for the detection of LVAD infection. The study of Kanapinn et al 10 published in this issue illustrated nicely how FDG-PET might find a role in the identification of LVAD infection.…”

Section: Nuclear Imaging For the Detection Of Lvad Infectionmentioning

confidence: 99%

“…SUV for the detection of infection. Interestingly, Dell'Aquila et al 9 confirmed that the diagnostic performance of FDG-PET is excellent for the detection of driveline infection, but lower for pump infection. The results of these retrospective studies suggest that the probability of driveline infection is high in presence of intense FDG uptake (max.…”

Section: Diagnostic Criteria For Lvad Infection Using Fdg-pet Imagingmentioning

confidence: 99%

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FDG-PET for the detection of infection in left ventricle assist device: Is there light at the end of the tunnel?

Hyafil

Rouzet

Benali

2019

Journal of Nuclear Cardiology

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LEFT VENTRICULAR ASSIST DEVICESOver the past decade, the use of continuous-flow left ventricular assist devices (LVAD) has increased at a rapid pace. In the United States, approximately 2400 LVAD are implanted annually 1 and more than 16,000 patients have already received a continuous-flow LVAD. 2 These devices are a life-saving option for advanced heart failure patients who are either not eligible for a heart transplant or too ill to safely wait for a transplant on medical therapy alone. LVAD constitute the following components: (1) an inflow cannula surgically implanted into the left ventricular apex that extracts the blood from the left ventricle (LV) into the pump; (2) a pump enclosure with an impeller that circulates blood; (3) an outflow graft that pulses back the blood from the pump into the ascending aorta; and (4) a surgically tunneled driveline that connects the pump to an external controller that operates and monitors the pump function. The external controller is connected by two power cables to a battery powered source or a power module. Survival rates of patients are continuously improving after implantation of LVAD, but the number of adverse events remains quite high. Approximately 80% of patients will have experienced a major adverse event in the first 2 years after LVAD implantation. The most frequent complications of LVAD are bleeding, infection, and arrhythmia. 3 LVAD infection starts usually at the entry point of the percutaneous driveline and extends from there progressively to the LVAD pump. In case of driveline infection, a new driveline can be implanted in another site and connected to the pump. In case of pump infection, replacing the LVAD pump is challenging because of the development of tight adhesions between the system and the heart. The only remaining option is to try to control the progression of pump infection with long-term systemic antibiotherapy and consider urgent cardiac transplant in eligible patients. The precise evaluation of the extent of infection in the LVAD system is, therefore, key to guide the clinical management of these patients. NUCLEAR IMAGING FOR THE DETECTION OF LVAD INFECTIONWhite blood cell (WBC) SPECT and FDG-PET have both demonstrated their values for the detection of infection in cardiac implantable electronic devices and prosthesis 4 and might thus prove useful for the evaluation of LVAD. On the one hand, WBC SPECT was the first to be evaluated in this indication in a small study including eight patients with a suspicion of LVAD infection. 5 The accumulation of radiolabeled WBC was found highly specific for LVAD infection in this small cohort of patients and allowed for the identification of the extent of infection along the device. The logistics for WBC SPECT imaging are, however, quite demanding for Nuclear Medicine departments with the need to handle blood and radiolabeled cells in a hot lab under sterile conditions, and for patients who undergo two

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Section: Nuclear Imaging For the Detection Of Lvad Infectionmentioning

confidence: 99%

Section: Diagnostic Criteria For Lvad Infection Using Fdg-pet Imagingmentioning

confidence: 99%

FDG-PET for the detection of infection in left ventricle assist device: Is there light at the end of the tunnel?

Hyafil

Rouzet

Benali

2019

Journal of Nuclear Cardiology

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“…3,[16][17][18] In this issue, de Vaugelade et al 19 retrospectively analyzed the diagnostic performance of both radiolabeled leucocyte scintigraphy and 18F-FDG PET/CT in 24 LVAD-recipients with suspected devicerelated infection. Their conclusion is that 18F-FDG PET/CT demonstrated a higher sensitivity compared to radiolabeled leucocyte scintigraphy and could be preferred as first-line radionuclide imaging procedure.…”

mentioning

confidence: 99%

“…The observance of this diet, which is easier to achieve during hospitalization, is of paramount importance to suppress physiological myocardial FDG uptake. After only a 6 h fasting without additional diet, Dell'Aquila et al 17 reported a poor discriminator power of 18F-FDG PET/CT for pump housing infection, although the diagnostic value for the infection of the piercing site of driveline infection or its intracorporeal course was excellent. Second, the interpretation criteria must be clearly defined.…”

mentioning

confidence: 99%

Diagnosis of infection in patients with left ventricular assist device: PET or SPECT?

Legallois

Manrique

2019

Journal of Nuclear Cardiology

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“…Besides mortality, LVAD infections are associated with increased risk of complications, longer hospital stay, need for LVAD exchange, and failure to transplant (36). The usefulness of WBC SPECT/CT and 18 F-FDG-PET/CT in the diagnosis and management of LVADrelated infection has been shown in small cohort of patients(38)(39)(40)(41)(42)(43)(44)(45). Semi-quantitative analysis may be used to improve -FDG-PET/CT performances(41,42).…”

mentioning

confidence: 99%

Detection of Device Infection Using Nuclear Cardiology Imaging

Sollini

Berchiolli

Bandera

et al. 2018

Annals of Nuclear Cardiology

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Cardiovascular device-related infections include infections occurring at heart valve prosthesis, cardiovascular implantable electronic devices, left ventricular assist device catheters and vascular graft. Complications, including infections associated with implanted medical devices have been increased. The diagnosis of cardiovascular device-related infections is challenging since symptoms and signs are often inconclusive and clinical presentations may be extremely heterogeneous. Imaging using the "3M" approach (i.e., multimodality, multi-tracers and multisciplinary) has been integrated into the traditional diagnostic criteria to fill such uncertainty gap with information on the biochemical burden of these infections. The present review aimed to provide an overview of the main applications and results of nuclear cardiology imaging in cardiovascular devicerelated infections.

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Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography for improving diagnosis of infection in patients on CF-LVAD: longing for more ‘insights’

Abstract: Quantitative 18F-FDG PET/CT is an optimal diagnostic tool in detecting superficial and deep driveline infections. However, diagnostic accuracy with regard to the diagnosis of pump housing infection is limited. Here, clinical and qualitative PET/CT analyses must be better considered.

Cited by 33 publications

References 13 publications

FDG-PET for the detection of infection in left ventricle assist device: Is there light at the end of the tunnel?

FDG-PET for the detection of infection in left ventricle assist device: Is there light at the end of the tunnel?

Diagnosis of infection in patients with left ventricular assist device: PET or SPECT?

Detection of Device Infection Using Nuclear Cardiology Imaging

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