(18)F-FDG positron emission tomography/computed tomography of cardiac implantable electronic device infections

BACKGROUND: The diagnosis of cardiac implantable electronic device (CIED) infection is challenging because of its variable presentations. We studied the value of 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) in the detection of CIED infection. METHODS AND RESULTS: Thirty patients with suspected CIED infection underwent (18)F-FDG-PET/CT. The control group was ten patients with asymptomatic CIED who underwent cancer-related (18)F-FDG-PET/CT. (18)F-FDG-PET/CT was evaluated visually, semiquantitatively as maximum standardized uptake value (SUV(max)) and target-to-background ratio (TBR). Final diagnosis of CIED infection was based on clinical and bacteriological data. (18)F-FDG-PET/CT was visually positive in all 9 patients with recent (≤ 8 weeks) implantation of CIED, but only 4 had confirmed CIED infection. (18)F-FDG-PET/CT was true positive in 9 out of 21 cases with remote implantation of CIED and false positive in 3 (14.3%) cases. (18)F-FDG-PET/CT was also false positive in 3 (30%) cases of control group. The SUV(max) of the pocket area was significantly higher in patients with CIED infection than in the control group (4.8 ± 2.4 vs 2.0 ± .8, P < .001). By using the cut-off value of TBR ≥ 1.8, sensitivity of (18)F-FDG-PET/CT for the diagnosis of CIED infection in patients with remote implantation was 90% and specificity 73%, PPV 75%, and NPV 89%. CONCLUSIONS: (18)F-FDG-PET/CT is a sensitive but nonspecific method in the diagnosis of CIED infection. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12350-020-02256-4) contains supplementary material, which is available to authorized users.