¹⁸F-FDG PET/CT-imaging of left ventricular assist device infection: a retrospective quantitative intrapatient...

Despite the use of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT), diagnosis of a driveline infection in ventricular assist device (LVAD) recipients remains challenging. Our aim was to evaluate the potential of a baseline ¹⁸F-FDG PET/CT (prior to an infection) for the diagnosis of an LVAD-related infection.

We retrospectively selected all LVAD recipients who had undergone two consecutive whole-body ¹⁸F-FDG PET/CT examinations between January 2010 and December 2016. PET/CT was analyzed qualitatively (uptake pattern) and semi-quantitatively (SUV_max and ∆SUV_max). SUV_max was measured and compared in five distinctive volumes of interest along the LVAD driveline. An SUV_max threshold was calculated. Final diagnosis was made by clinical examination, microbiological parameters, and molecular imaging.

Thirty patients were enrolled (mean age 54 ± 12 years; 26 male). Mean difference in SUV_max for all five positions between the first and the second PET/CT along the driveline was significantly higher in patients with an LVAD-related infection (mean ∆SUV_max = 4.38 ± 1.44) compared to those without a driveline infection (mean ∆SUV_max = 0.03 ± 0.43), P < 0.05. Applying ROC analysis, an SUV_max threshold of 3.88 resulted in a sensitivity and specificity of 100%, respectively. There were three distinctive uptake patterns in patients with a driveline infection.

PET/CT diagnosis in the context of an LVAD-related infection can be improved by comparison to a baseline examination using a distinctive SUV_max threshold.