Positron Emission Tomography and Single-Photon Emission Computed Tomography Imaging in the Diagnosis of Cardiac Implantable Electronic Device Infection

Juneau, Daniel; Golfam, Mohammad; Hazra, Samir Kumar; Zuckier, Lionel S.; S, Garas; Redpath, Calum J.; Bernick, Jordan; Leung, Eugene; Chih, Sharon; Wells, George A.; Beanlands, Rob; Chow, Benjamin J.W.

doi:10.1161/circimaging.116.005772

Cited by 132 publications

(68 citation statements)

References 30 publications

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“…Fluoro-18-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET/CT) has been shown to be useful in early CIED infection and also differentiating between CIED infection and recent postimplant changes 17 18. In a systematic review by Juneau et al ,19 the pooled sensitivity of 18 F-FDG PET/CT for the diagnosis of CIED infection was 87% and pooled specificity was 94%. The use of 99m Tc-hexamethypropylene amine oxime-labelled autologous white blood cell ( 99m Tc-HMPAO-WBC) single-photon emission CT/CT (SPECT/CT) has also been examined in suspected CIED infections.…”

Section: Introductionmentioning

confidence: 99%

Contemporary management of cardiac implantable electronic device infection

DeSimone

Sohail

Mulpuru

2019

Heart

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Section: Introductionmentioning

confidence: 99%

Contemporary management of cardiac implantable electronic device infection

DeSimone

Sohail

Mulpuru

2019

Heart

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“…A systematic review showed a sensitivity of 73%-100% and a specificity of 71%-100% for 18 F-FDG PET/CT in the diagnosis of infection in the pocket of a cardiac implantable electronic device (15). A second metaanalysis showed similar results, with a pooled sensitivity of 87% and specificity of 94% (16). For device-related or prosthetic endocarditis diagnosis, it has been shown that adding 18 F-FDG PET/CTpositive findings as a major criterion to the modified Duke criteria increased diagnosis sensitivity from 52%-70% to 91%-97% without compromising specificity (17,18).…”

Section: Functional Imaging Toolsmentioning

confidence: 90%

Molecular Imaging of Cardiovascular Device Infection: Targeting the Bacteria or the Host–Pathogen Immune Response?

Chen¹,

Dilsizian²

2020

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to (1) understand the role of 18 F-FDG PET/CT for diagnosis of cardiovascular device infection, as a functional imaging tool for assessing the overall host-pathogen immune response in infection; (2) learn about the strengths and limitations of bacteria-targeting radiotracers for infection imaging, including those based on substances of bacterial maltodextrin transporters, bacterial thymidine kinase, antibiotics, antimicrobial peptides, antibacterial antibodies, bacteriophages, and bacterial DNA/RNA hybrid nucleotide oligomers; and (3) discuss the pros and cons of 18 F-FDG versus bacteria-targeting tracers. Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through March 2023. Rapid and accurate diagnosis of cardiovascular device infection remains a challenge in the clinic. Anatomic imaging tools such as echocardiography and cardiac CT or CT angiography are the firstline modalities for clinically suspected endocarditis given their ability to detect vegetation and perivalvular complications. Accumulating data suggest that functional imaging with 18 F-FDG PET/CT has unique merits over anatomic imaging and could potentially diagnose early cardiac device infection before morphologic damage ensues and identify infection sources or bacterial emboli in the rest of the body. Although an abnormal finding on 18 F-FDG PET/CT was added to the 2015 guidelines of the European Society of Cardiology as a major criterion for the diagnosis of device-related and prosthetic valve endocarditis, that addition has not been incorporated in the U.S. guidelines. Beyond these clinically available imaging tools, attempts have been made to develop bacteria-targeting tracers for specific infection imaging, which include tracers of bacterial maltodextrin transporter, bacterial thymidine kinase, antibiotics, antimicrobial peptides, bacterial antibodies, bacteriophages, and bacterial DNA/RNA hybrid nucleotide oligomers. Most of the tracers have been studied only in experimental animals, except for radiolabeled antibiotics, which have been examined in humans without success in clinical translation for infection imaging. In this article, we compare the roles of anatomic and functional imaging for cardiac device infection and discuss the pros and cons of 18 F-FDG and bacteria-targeting tracers. While anticipating continued investigations for bacteria-specific...

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“…15,18,22,[26][27][28][29][30][31] However, one caveat is that the majority of studies evaluating diagnostic accuracy in suspected CIED-GPI only include confirmed cases or those with medium-to-high pre-test probability. Paradoxically, patients at the opposite end of the spectrum (with a lower pre-test probability of infection at initial presentation) are generally considered to pose a greater diagnostic challenge and by comparison are relatively underrepresented in these studies; arguably, a novel non-invasive diagnostic tool would be most useful in this group of patients, and further studies assessing the performance of 18 F-FDG in this group are desirable.…”

Section: Historical Perspectivementioning

confidence: 99%

“…Notably, studies of ventricular assist device (VAD) infection were also included in this analysis. 26 …”

Section: Historical Perspectivementioning

confidence: 99%

18F-FDG PET/CT now endorsed by guidelines across all types of CIED infection: Evidence limited but growing

Ahmed

Arumugam

2019

Journal of Nuclear Cardiology

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Positron Emission Tomography and Single-Photon Emission Computed Tomography Imaging in the Diagnosis of Cardiac Implantable Electronic Device Infection

Abstract: Both F-FDG PET-CT and LS yield high sensitivity, specificity, and accuracy, and thus seem to be useful for the diagnosis of CIED infection, based on robust data forF-FDG PET-CT but limited data for LS. When available,F-FDG PET-CT may be preferred.

Cited by 132 publications

References 30 publications

Contemporary management of cardiac implantable electronic device infection

Contemporary management of cardiac implantable electronic device infection

Molecular Imaging of Cardiovascular Device Infection: Targeting the Bacteria or the Host–Pathogen Immune Response?

18F-FDG PET/CT now endorsed by guidelines across all types of CIED infection: Evidence limited but growing

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