Diagnosing Left Ventricular Assist Device Infection Using [ 18 F]Fluorodeoxyglucose Positron Emission...

Area of Science:

• Cardiology
• Nuclear Medicine
• Infectious Diseases

Background:

• Diagnosing left ventricular assist device (LVAD) infections, especially bloodstream infections (BSI), is challenging due to device accessibility and imaging artifacts.
• Accurate diagnosis is crucial for timely and effective treatment, impacting patient outcomes.

Purpose of the Study:

• To evaluate the diagnostic performance of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in detecting LVAD-related BSI.
• To compare FDG-PET/CT findings with standard clinical parameters for BSI diagnosis.

Main Methods:

• Sixty-one patients with suspected LVAD infection underwent FDG-PET/CT.
• FDG uptake at various LVAD components and lymphadenopathy were assessed using the Deauville score (DS).
• Clinical parameters including C-reactive protein (CRP), body temperature, white blood cell count (WBC), and blood cultures were documented.

Main Results:

• 52% of patients had positive blood cultures for BSI.
• Clinical parameters showed limited correlation with DS; CRP and WBC had moderate sensitivity and specificity for BSI.
• FDG-PET/CT-based DS of central LVAD components, particularly the pump and outflow cannula, showed higher sensitivity when combined with lymphadenopathy assessment.

Conclusions:

• FDG-PET/CT, especially when assessing central LVAD components and lymphadenopathy, offers superior diagnostic performance for LVAD-related BSI compared to clinical parameters alone.
• This imaging modality supports individualized therapeutic strategies for LVAD infections.