Diagnostic Accuracy of FDG PET/CT in Suspected LVAD InfectionsA Case Series, Systematic Review, and Meta-Analysis
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Author + information
- Marty C. Tam, MDa,∗ (mctam{at}med.umich.edu),
- Vaiibhav N. Patel, MDa,
- Richard L. Weinberg, MD, PhDa,
- Edward A. Hulten, MD, MPHb,c,
- Keith D. Aaronson, MD, MSa,
- Francis D. Pagani, MD, PhDd,
- James R. Corbett, MDa and
- Venkatesh L. Murthy, MD, PhDa
- aDivision of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- bDepartment of Medicine,, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
- cDepartment of Medicine, Uniformed Services University, Bethesda, Maryland
- dDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. Marty C. Tam, Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 East Medical Center Drive, 2381 CVC, Ann Arbor, Michigan 48109-5873.
Central Illustration
Abstract
Objectives The purpose of this study was to describe our experience with fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET/CT) in diagnosing left ventricular assist device (LVAD) infections and perform a meta-analysis of published studies to determine overall diagnostic accuracy.
Background Device-related infections are a common complication of LVADs and are linked to worse outcomes. Diagnosis of LVAD infections remains challenging. FDG PET/CT has demonstrated good diagnostic accuracy in several other infectious conditions.
Methods This was a single-center, retrospective case series of FDG PET/CT scans in suspected LVAD infection between September 2015 and February 2018. A systematic review of PubMed from database inception through March 2018 was also conducted to identify additional studies.
Results Nineteen FDG PET/CT scans were identified for the retrospective case series. The systematic review identified an additional 3 publications, for a total of 4 studies involving 119 scans assessing diagnostic performance. Axial (n = 36) and centrifugal (n = 83) flow LVADs were represented. Pooled sensitivity was 92% (95% confidence interval [CI]: 82% to 97%) and specificity was 83% (95% CI: 24% to 99%) for FDG PET/CT in diagnosing LVAD infections. Summary receiver-operating characteristic curve analysis demonstrated an AUC of 0.94 (95% CI: 0.91 to 0.95).
Conclusions FDG PET/CT for suspected LVAD infections demonstrates good diagnostic accuracy, with overall high sensitivity but variable specificity.
- diagnostic testing
- heart failure
- infection
- left ventricular assist device
- meta-analysis
- positron emission tomography
Footnotes
The identification of specific products or scientific instrumentation is considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of the author, Department of Defense, or any component agency. The views expressed in this manuscript are those of the author and do not reflect the official policy of the Department of the Army, Department of Defense, or U.S. government. Dr. Murthy is supported by National Heart, Lung and Blood Institute grant R01-HL136685; has received research grant support from Siemens Medical Imaging and INVIA Medical Imaging Solutions; owns stock in General Electric and Cardinal Health and stock options in Ionetix; and has served as an advisor for Curium and Ionetix. Dr. Aaronson has received institutional contracted research support from Medtronic and Abbott; and served on the advisory board for Medtronic. Dr. Corbett owns equity in INVIA Medical Imaging Solutions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 11, 2018.
- Revision received April 1, 2019.
- Accepted April 4, 2019.
- 2019 American College of Cardiology Foundation
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