Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections

J Am Coll Cardiol. 2012 May 1;59(18):1616-25. doi: 10.1016/j.jacc.2011.11.059.


Objectives: This study evaluated the usefulness of fluorodesoxyglucose marked by fluorine-18 ((18)F-FDG) positron emission tomography (PET) and computed tomography (CT) in patients with suspected cardiovascular implantable electronic device (CIED) infection.

Background: CIED infection is sometimes challenging to diagnose. Because extraction is associated with significant morbidity/mortality, new imaging modalities to confirm the infection and its dissemination would be of clinical value.

Methods: Three groups were compared. In Group A, 42 patients with suspected CIED infection underwent (18)F-FDG PET/CT. Positive PET/CT was defined as abnormal uptake along cardiac devices. Group B included 12 patients without infection who underwent PET/CT 4 to 8 weeks post-implant. Group C included 12 patients implanted for >6 months without infection who underwent PET/CT for another indication. Semi-quantitative ratio (SQR) was obtained from the ratio between maximal uptake and lung parenchyma uptake.

Results: In Group A, 32 of 42 patients with suspected CIED infection had positive PET/CT. Twenty-four patients with positive PET/CT underwent extraction with excellent correlation. In 7 patients with positive PET/CT, 6 were treated as superficial infection with clinical resolution. One patient with positive PET/CT but negative leukocyte scan was considered false positive due to Dacron pouch. Ten patients with negative-PET/CT were treated with antibiotics and none has relapsed at 12.9 ± 1.9 months. In Group B, patients had mild uptake seen at the level of the connector. There was no abnormal uptake in Group C patients. Median SQR was significantly higher in Group A (A = 2.02 vs. B = 1.08 vs. C = 0.57; p < 0.001).

Conclusions: PET/CT is useful in differentiating between CIED infection and recent post-implant changes. It may guide appropriate therapy.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Arrhythmias, Cardiac / therapy
  • Cardiovascular Infections / diagnosis*
  • Cardiovascular Infections / epidemiology
  • Cardiovascular Infections / etiology
  • Defibrillators, Implantable / microbiology*
  • Diagnosis, Differential
  • Female
  • Fluorodeoxyglucose F18*
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Morbidity / trends
  • Multimodal Imaging / statistics & numerical data*
  • Myocarditis / diagnosis*
  • Myocarditis / epidemiology
  • Myocarditis / etiology
  • Positron-Emission Tomography*
  • Prospective Studies
  • Prosthesis-Related Infections / diagnosis*
  • Quebec / epidemiology
  • Radiopharmaceuticals
  • Reproducibility of Results
  • Tomography, X-Ray Computed*


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18