Author + information
- Received June 23, 2015
- Revision received September 7, 2015
- Accepted September 10, 2015
- Published online March 1, 2016.
- Sana Amraoui, MDa,∗ (, )
- Ghoufrane Tlili, MDb,
- Manav Sohal, MBBSc,
- Benjamin Berte, MDa,
- Elif Hindié, MD, PhDb,
- Philippe Ritter, MDa,
- Sylvain Ploux, MD, PhDa,
- Arnaud Denis, MDa,
- Nicolas Derval, MDa,
- Christopher A. Rinaldi, MD, PhDc,
- Charles Cazanave, MDd,
- Pierre Jais, MD, PhDa,
- Michel Haissaguerre, MD, PhDa,
- Laurence Bordenave, MD, PhDb and
- Pierre Bordachar, MD, PhDa
- aUniversité de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
- bCHU de Bordeaux, Service de Médecine Nucléaire et CIC 1401, Bordeaux, France
- cGuy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- dCHU de Bordeaux, Department of Infectious and Tropical Diseases, Hôpital Pellegrin, Bordeaux, France
- ↵∗Reprint requests and correspondence:
Dr. Sana Amraoui, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France.
Objectives The aim of this study was to investigate the role of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scanning in identifying septic embolism in patients with lead endocarditis.
Background Lead endocarditis may be associated with septic embolism, in which case the administration mode, type, and duration of antibiotic therapy must be adapted. However, diagnosis can be challenging: magnetic resonance imaging (MRI) cannot be performed in the vast majority of patients with cardiac implantable electronic devices (CIEDs). FDG PET/CT scanning has been proposed as a diagnostic tool for suspected CIED infection.
Methods Thirty-five consecutive patients with lead endocarditis were prospectively studied. FDG PET/CT scanning was performed and analyzed blindly by experienced nuclear medicine physicians to assess for the presence of septic embolism 2 days before lead extraction.
Results FDG PET/CT scanning identified septic emboli in 10 patients (29%): 7 with spondylodiscitis, 2 with septic pulmonary emboli, and 1 with an infected vascular prosthesis. Among the 7 patients with occult spondylodiscitis, 4 were asymptomatic, and 3 had back pain with negative CT imaging, MRI being contraindicated due to non MRI-compatible CIEDs. Antimicrobial therapy was adapted (double antibiotic therapy with good bone penetration) and prolonged. Among other important ancillary findings, 3 patients presented focal FDG uptake in the colon (1 adenocarcinoma, and 2 resected polyps) and 2 in the esophagus (both cases confirmed as neoplasia).
Conclusions This study emphasizes the potential utility of FDG PET/CT scanning as a diagnostic tool for septic emboli in patients with pacing lead endocarditis. This promising diagnostic tool may be integrated in the diagnostic algorithm of patients with lead endocarditis because diagnosis of septic embolisms has a direct and significant impact on the therapeutic care pathway.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 23, 2015.
- Revision received September 7, 2015.
- Accepted September 10, 2015.
- American College of Cardiology Foundation