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Metabolic volume performs better than SUVmax in the detection of left ventricular assist device driveline infection

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

A continuous-flow left ventricular assist device (LVAD) is a new and highly promising therapy in supporting end-stage heart failure patients, either bridging them to heart transplantation or as a destination therapy. Infection is one of the major complications associated with LVAD implants. 18F–FDG PET/CT has already been shown to be useful in the detection of LVAD infection. The goal of this study was to compare the diagnostic accuracy of different PET analysis techniques (visual grading versus SUVmax and metabolic volume).

Methods

We retrospectively analyzed 48 patients with implanted LVAD who underwent an 18F–FDG PET/CT that were either suspected to have a driveline or device infection or inflammation of unknown origin. PET/CT was analyzed qualitatively (visual grading) and quantitatively (SUVmax and metabolic volume) and matched to the final clinical diagnosis concerning driveline infection. The final diagnosis (standard of reference) was made at the end of clinically recorded follow-up or transplantation and included microbiological cultures of the driveline exit site and/or surgical samples, and clinical signs of infection despite negative cultures as well as recurrence of symptoms.

Results

Sensitivity, specificity, positive and negative predictive value were 87.5%, 79%, 81% and 86% for visual score, 87.5%, 87.5%, 87.5% and 87.5% for SUVmax and 96%, 87.5%, 88.5%, 95.5% for metabolic volume, respectively. ROC analysis revealed an AUC of .929 for SUVmax and .969 for metabolic volume. Both SUVmax and metabolic volume had a high detection rate of patients with driveline infection (21/24 = 91.5% true positive vs. 23/26 = 88.5% true positive, respectively). However, metabolic volume detected more patients without any infection correctly (1/22 = 4.5% false negative vs. 3/24 = 12.5% false negative).

Conclusions

18F–FDG PET/CT is a valuable tool for the diagnosis of LVAD driveline infection with high diagnostic accuracy. Particularly the use of the metabolic volume yields very high accuracy and performs slightly better than SUVmax.

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Author information

Author notes

  1. Nemanja Avramovic and Angelo Maria Dell'Aquilla contributed equally to this work

  2. Jürgen R Sindermann and Christian Wenning also contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Münster, Münster, Germany

    Nemanja Avramovic, Matthias Weckesser, Danka Milankovic, Alexis Vrachimis & Christian Wenning

  2. Department of Cardiac Surgery, University Hospital Münster, Münster, Germany

    Angelo Maria Dell’Aquila & Jürgen R. Sindermann

Authors
  1. Nemanja Avramovic
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  2. Angelo Maria Dell’Aquila
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  3. Matthias Weckesser
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  4. Danka Milankovic
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  5. Alexis Vrachimis
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  6. Jürgen R. Sindermann
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  7. Christian Wenning
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Corresponding author

Correspondence to Nemanja Avramovic.

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Funding

No funding was received for this retrospective study.

Conflict of interest

The authors declare they have no conflict of interest according the subject and matter presented in this manuscript.

Ethical standards

This study was approved by the University of Münster Ethical Committee and Institutional Review Board. Therefore, it has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their written informed consent for the PET examination.

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Avramovic, N., Dell’Aquila, A.M., Weckesser, M. et al. Metabolic volume performs better than SUVmax in the detection of left ventricular assist device driveline infection. Eur J Nucl Med Mol Imaging 44, 1870–1877 (2017). https://doi.org/10.1007/s00259-017-3732-2

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  • DOI: https://doi.org/10.1007/s00259-017-3732-2

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