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      18F-FDG PET/CT in Left-Ventricular Assist Device Infection: Initial Results Supporting the Usefulness of Image-Guided Therapy

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          Abstract

          Accurate definition of the extent and severity of left-ventricular assist device (LVAD) infection may facilitate therapeutic decision making and targeted surgical intervention. Here, we explore the value of 18F-FDG PET/CT for guidance of patient management. Methods: Fifty-seven LVAD-carrying patients received 85 whole-body 18F-FDG PET/CT scans for the work-up of device infection. Clinical follow-up was obtained for up to 2 y. Results: PET/CT showed various patterns of infectious involvement of the 4 LVAD components: driveline entry point (77% of patients), subcutaneous driveline path (87%), pump pocket (49%), and outflow tract (58%). Driveline smears revealed Staphylococcus or Pseudomonas strains as the underlying pathogen in most cases (48 and 34%, respectively). At receiver-operating-characteristic analysis, an 18F-FDG SUV of more than 2.5 was most accurate to identify smear-positive driveline infection. Infection of 3 or all 4 LVAD components showed a trend toward lower survival than did infection of 2 or fewer components ( P = 0.089), whereas involvement of thoracic lymph nodes was significantly associated with an adverse outcome ( P = 0.001 for nodal SUV above vs. below median). Finally, patients who underwent early surgical revision within 3 mo after PET/CT ( n = 21) required significantly less inpatient hospital care during follow-up than did those receiving delayed surgical revision ( n = 11; P < 0.05). Conclusion: Whole-body 18F-FDG PET/CT identifies the extent of LVAD infection and predicts adverse outcome. Initial experience suggests that early image-guided surgical intervention may facilitate a less complicated subsequent course.

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          Author and article information

          Journal
          J Nucl Med
          J. Nucl. Med
          jnumed
          jnm
          Journal of Nuclear Medicine
          Society of Nuclear Medicine
          0161-5505
          1535-5667
          July 2020
          1 January 2021
          : 61
          : 7
          : 971-976
          Affiliations
          [1 ]Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany; and
          [2 ]Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
          Author notes
          For correspondence or reprints contact: Frank M. Bengel, Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. E-mail: bengel.frank@ 123456mh-hannover.de
          [*]

          Contributed equally to this work.

          Published online Dec. 5, 2019.

          Article
          PMC7383076 PMC7383076 7383076 237628
          10.2967/jnumed.119.237628
          7383076
          31806770
          3630a92b-4002-48db-a8d8-1d166355a38f
          © 2020 by the Society of Nuclear Medicine and Molecular Imaging.
          History
          : 02 October 2019
          : 11 November 2019
          Page count
          Pages: 6
          Categories
          Cardiovascular
          Clinical

          device infection, 18F-FDG,PET/CT,left ventricular assist device

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