The value of 18F-FDG PET/CT for the diagnosis of device-related infections in patients with a left ventricular assist device: a systematic review and meta-analysis

D Ten Hove; G Treglia; R H J A Slart; K Damman; M Wouthuyzen-Bakker; D F Postma; O Gheysens; R J H Borra; G Mecozzi; P P van Geel; B Sinha; A W J M Glaudemans

doi:10.1007/s00259-020-04930-8

The value of ¹⁸F-FDG PET/CT for the diagnosis of device-related infections in patients with a left ventricular assist device: a systematic review and meta-analysis

Eur J Nucl Med Mol Imaging. 2021 Jan;48(1):241-253. doi: 10.1007/s00259-020-04930-8. Epub 2020 Jun 27.

Authors

D Ten Hove^{1

2}, G Treglia^{3

4

5}, R H J A Slart^{6

7}, K Damman⁸, M Wouthuyzen-Bakker⁹, D F Postma¹⁰, O Gheysens¹¹, R J H Borra^{6

12}, G Mecozzi¹³, P P van Geel⁸, B Sinha⁹, A W J M Glaudemans⁶

Affiliations

¹ Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands. d.ten.hove@umcg.nl.
² Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. d.ten.hove@umcg.nl.
³ Clinic of Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona and Lugano, Switzerland.
⁴ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁵ Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Via Lugano 4F, CH-6500, Bellinzona, Switzerland.
⁶ Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
⁷ Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
⁸ University of Groningen, Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁹ Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
¹⁰ Department of Internal Medicine and infectious diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
¹¹ Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
¹² Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
¹³ Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Abstract

Background: Left ventricular assist devices (LVADs) are increasingly used for the treatment of advanced heart failure. LVADs improve quality of life and decrease mortality, but the driveline carries substantial risk for major infections. These device-related LVAD and driveline infections are difficult to diagnose with conventional imaging. We reviewed and analysed the current literature on the additive value of ¹⁸F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) imaging for the diagnosis of LVAD-related infections."

Materials/methods: We performed a systematic literature review using several databases from their inception until the 31st of December, 2019. Studies investigating the diagnostic performance of FDG-PET/CT in patients with suspected LVAD infection were retrieved. After a bias risk assessment using QUADAS-2, a study-aggregate meta-analysis was performed on a per examination-based analysis.

Results: A total of 10 studies were included in the systematic review, eight of which were also eligible for study-aggregate meta-analysis. For the meta-analysis, a total of 256 FDG-PET/CT scans, examining pump/pocket and/or driveline infection, were acquired in 230 patients. Pooled sensitivity of FDG-PET/CT was 0.95 (95% confidence interval (CI) 0.89-0.97) and pooled specificity was 0.91 (95% CI 0.54-0.99) for the diagnosis of device-related infection. For pump/pocket infection, sensitivity and specificity of FDG-PET/CT were 0.97 (95%CI 0.69-1.00) and 0.93 (95%CI 0.64-0.99), respectively. For driveline infection, sensitivity and specificity were 0.96 (95%CI 0.88-0.99) and 0.99 (95%CI 0.13-1.00) respectively. Significant heterogeneity existed across studies for specificity, mostly caused by differences in scan procedures. Predefined criteria for suspicion of LVAD and/or driveline infection were lacking in all included studies.

Conclusions: FDG-PET/CT is a valuable tool for assessment of device-related infection in LVAD patients, with high sensitivity and high, albeit variable, specificity. Standardization of FDG-PET/CT procedures and criteria for suspected device-related LVAD infections are needed for consistent reporting of FDG-PET/CT scans.

Keywords: 18F-FDG PET/CT; LVAD infection; Meta-analysis; Systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Fluorodeoxyglucose F18
Heart-Assist Devices* / adverse effects
Humans
Positron Emission Tomography Computed Tomography
Positron-Emission Tomography
Prosthesis-Related Infections* / diagnostic imaging
Quality of Life
Radiopharmaceuticals
Sensitivity and Specificity

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18