Abstract
Objective: to investigate the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/
computed tomography (PET/CT) in patients with suspected intracardiac device (ICD) infection.
Material and methods. The prospective analysis included results of 18F-FDG PET/CT examinations performed in 20
patients with fever of unknown origin after (median 29 months) ICD implantation, of which 6 had also prosthetic
heart valves; 6/20 patients had local signs of pocket infection. PET/CT scan was performed 90 min after intravenous
injection of 18F-FDG (175–200 MBq). All PET/CT results were confirmed according to clinical, laboratory and
intraoperative (n=12) data.
Results. In patients with suspected ICD infection PET/CT correctly confirmed the diagnosis in 9 and ruled it out in
11 patients.
In patients without ICD infection (n=11) the prosthetic valve area was also assessed – infectious process revealed
(n=3) and ruled out (n=2).
All patients with local signs of pocket infection (6/9) had abnormal 18F-FDG uptake not only in the pocket site, but
also along the leads – its extra- and intracardiac portions. In 3/9 cases PET/CT showed infectious process along both
extra- and intracardiac portions of leads, including the prosthetic valve area in one patient.
Importantly, among 9 patients with true positive PET/CT results and confirmed ICD infection – 3/9 had positive
echo findings and 3/9 – positive blood cultures, and only one patient had both – positive echo and blood cultures.
In 6/9 patients with true positive PET/CT were also diagnosed with other than device previously unknown lesions of
inflammation: in the prosthetic valve area, in infiltrates of the anterior chest wall (previous pockets), in lungs and left
knee. In one patient colon cancer was revealed.
Conclusion. According to initial results, 18F-FDG PET/CT proved to be a useful diagnostic tool in patients with suspected
ICD infection – it’s informative for assessment of the pocket, as well as the extra- and intracardiac portions
of leads. PET/CT should be included in the algorithm for early diagnosis, especially in patients with negative echo
and/or blood cultures. Obtained results determined the therapeutic approach in the analyzed patients.
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About the authors
- Leo A. Bockeria, Academician of RAS and RAMS, Director, orcid.org/0000-0002-6180-2619
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Irakliy P. Aslanidi, Dr. Med. Sc., Professor, Head of the Department, orcid.org/0000-0001-6386-2378
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Diana M. Pursanova, Cand. Med. Sc., Researcher, orcid.org/0000-0002-1846-0115
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Ol’ga V. Mukhortova, Dr. Med. Sc., Senior Researcher, orcid.org/0000-0002-7716-5896
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Irina V. Shurupova, Dr. Med. Sc., Senior Researcher, orcid.org/0000-0002-2154-474X
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Irina V. Ekaeva, Cand. in Chemystry, Senior Researcher, orcid.org/0000-0002-5396-604X
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Sergey Yu. Serguladze, Dr. Med. Sc., Head of the Department, orcid.org/0000-0001-7233-3611
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Renat M. Muratov, Dr. Med. Sc., Professor, Head of the Department, orcid.org/0000-0003-3321-9028
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Marina V. Nezhdanova, Dr. Med. Sc., Head of the Department
