Author + information
- Hiroko Beck, MD⁎ (, )
- Vasken Dilsizian, MD and
- Timm Dickfeld, MD, PhD
- ↵⁎School of Medicine, Division of Cardiology, Clinical Electrophysiology and Department of Diagnostic Radiology and Nuclear Medicine, 22 South Greene Street, Room N3W77, Baltimore, Maryland 21201
We read with strong interest the paper by Sarrazin et al. (1), which reported on the utility of Fluorine-18 (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for identification of cardiovascular implantable electronic device (CIED) infections. As noted in the article, the diagnosis of CIED infections can be very challenging, and unnecessary device extraction can expose the patient to significant morbidity and mortality (2,3). The paper suggested a high sensitivity and specificity of 18F-FDG PET/CT in differentiating pocket and/or lead infections from non-infected devices older than 6 months. However, the control group in the study was small (only 10 patients), and the prevalence of increased nonspecific 18F-FDG uptake in not-infected CIED patients is unknown. To further validate the negative control, we decided to review 69 18F-FDG PET/CT scans performed on patients with remote implantable cardioverter-defibrillator (ICD) insertion for elective reasons. All patients with remote ICD insertion and no clinical/laboratory evidence of infection undergoing 18F-FDG PET/CT in preparation for ventricular tachycardia ablation from 2006 to 2011 were identified in our institution. Semi-quantitative assessment of 18F-FDG uptake was assessed in 4 sites (generator pocked, innominate vein, superior vena cava, and intracardiac space [right atrium/ventricle]). Uptake was categorized in none (score = 0), mild (≤thoracic background activity; score = 1), moderate (>thoracic background activity; score = 2), and severe hypermetabolism (very intense uptake; score = 3). Evaluation of 69 contiguous patients revealed 18F-FDG signal uptake scores of 0 in all segments. Thus, our data further strengthens the validity of negative controls in the current paper and supports a potential use of 18F-FDG PET/CT in differentiating patients with CIED infection from chronic implant changes, providing a new path in management of CIED infection.
- American College of Cardiology Foundation