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FDG PET/CT for Diagnosing LVAD Infections
Study Questions:
What is the diagnostic accuracy of fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET/CT) in diagnosing left ventricular assist device (LVAD) infections?
Methods:
The investigators conducted 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. For the case series, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were determined. For the meta-analysis, extracted data were used to determine pooled sensitivity, specificity, and summary receiver-operating characteristic curves with area under the curve (AUC). A generalized linear mixed model approach for diagnostic test accuracy using random effects was used with meta-analysis commands.
Results:
Nineteen FDG PET/CT scans were identified for the retrospective case series. The systematic review identified an additional three publications, for a total of four 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], 82-97%) and specificity was 83% (95% CI, 24-99%) for FDG PET/CT in diagnosing LVAD infections. Summary receiver-operating characteristic curve analysis demonstrated an AUC of 0.94 (95% CI, 0.91-0.95).
Conclusions:
The authors concluded that FDG PET/CT for suspected LVAD infections demonstrates good diagnostic accuracy, with overall high sensitivity but variable specificity.
Perspective:
This case series and systematic review on the use of FDG PET/CT in diagnosing LVAD infections reports that FDG PET/CT demonstrated good diagnostic accuracy, with overall high sensitivity but variable specificity. Of note, there was a notably high sensitivity based on this case series (100%) and the meta-analysis (92%), suggesting that this modality may be particularly useful in ruling out infections when there is a low to intermediate pretest probability. However, specificity was lower for the case series (25%), although it was higher in the meta-analysis (83%) with wide CIs, which suggests less usefulness for ruling in infections. Additional studies should focus on improving the specificity of the test to have greater clinical utility.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support, Interventions and Imaging, Computed Tomography, Nuclear Imaging
Keywords: Cardiac Surgical Procedures, Diagnostic Imaging, Diagnostic Tests, Routine, Fluorodeoxyglucose F18, Heart-Assist Devices, Heart Failure, Infections, Positron-Emission Tomography, Radionuclide Imaging, Sensitivity and Specificity, Tomography, X-Ray Computed
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