Usefulness of 18F-FDG PET/CT in patients with Cardiac Implantable Electronic Device Suspected for Late Infection

Presence of cardiovascular implantable electronic device (CIED) can be burdened by complications such as late infections that are associated with significant morbidity and mortality and require immediate and effective treatment. The aim of this study was to evaluate the role of 18F-FDG PET/CT in patient with suspected CIED infection. Fifteen patients who performed a 18F-FDG PET/CT for suspicion of CIED infection were retrospectively analyzed; 15 patients, with CIED, that underwent 18F-FDG PET/CT for oncological reasons, were also evaluated. Visual qualitative analysis and semiquantitative analysis were performed. All patients underwent standard clinical management regardless 18F-FDG PET/CT results. Concordance between 18F-FDG PET/CT and patients’ outcome was good (K = 0.659). Sensitivity, Specificity, Accuracy, PPV and NPV resulted 91%, 75%, 87%, 91% and 75% respectively. SUVmax and SemiQuantitative Ratio (SQR) were collected and showed differences statistically significant between CIED infection and not. Hypothetical cut-off values were derived from ROC curves for SUVmax (2.56) and SQR (4.15). This study suggests the clinical usefulness of 18F-FDG PET/CT in patients with CIED infection due to its high sensitivity, repeatability and non-invasiveness. It can help the clinicians in decision making, especially in patients with doubtful clinical presentation. Future large-scale and multicentric studies should be conducted to establish precise protocols about 18F-FDG PET/CT performance.