Metabolic volume performs better than SUVmax in the detection of left ventricular assist device driveline infection

Avramović, Nemanja; Dell’Aquila, Angelo M.; Weckesser, Matthias; Milankovic, Danka; Vrachimis, Alexis; Sindermann, Jürgen R.; Wenning, Christian

doi:10.1007/s00259-017-3732-2

Cited by 26 publications

(40 citation statements)

References 15 publications

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“…SUV associated with high probability of LVAD infection might thus be achievable. In a similar work, Avramovic et al 7 found that the quantification of global metabolic activity in the driveline on PET performed slightly better than max. SUV for the detection of infection.…”

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

confidence: 92%

“…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%

“…The results of these retrospective studies suggest that the probability of driveline infection is high in presence of intense FDG uptake (max. SUV [7][8] on PET, but these diagnostic criteria will need to be validated in multi-centric prospective studies with a larger number of patients. In the similar way as with patients with a suspicion of PVE, 11 WBC SPECT might be useful for patients with inconclusive FDG-PET, either in patients with borderline FDG uptake values or in the pump region where the precise analysis and quantification of FDG uptake is more difficult.…”

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: Diagnostic Criteria For Lvad Infection Using Fdg-pet Imagingmentioning

confidence: 92%

Section: Nuclear Imaging For the Detection Of Lvad Infectionmentioning

confidence: 99%

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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“…As a result, Vaugelade et al considered that a circumferential and homogeneous 18F-FDG uptake was a negative pattern for infection, defining positivity as a focal 18F-FDG uptake observed on both attenuation-corrected and uncorrected images in order to avoid overcorrection artifacts. 19 Although previous findings emphasized the impact of quantitative analysis, 21 Vaugelade et al found no difference between visual and quantitative analysis of 18F-FDG PET/CT for the diagnosis of LVAD-related infection.…”

mentioning

confidence: 91%

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).…”

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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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Metabolic volume performs better than SUVmax in the detection of left ventricular assist device driveline infection

Abstract: F-FDG PET/CT is a valuable tool for the diagnosis of LVAD driveline infection with high diagnostic accuracy. Particularly the use of the metabolic volume yields very high accuracy and performs slightly better than SUVmax.

Cited by 26 publications

References 15 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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