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The performance of quantitation methods in the evaluation of cardiac implantable electronic device (CIED) infection: A technical review

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Quantitative assessment of [18F]-FDG PET/CT images has been shown to be useful in the diagnosis of cardiac implantable electronic device (CIED) infection. This study aimed to compare the accuracy of various quantitative methods, using the same patient cohort and to assess the utility of dual time point imaging.

Methods

The study comprised a retrospective review of 80 [18F]-FDG PET/CT studies. Of these, 41 were oncological patients with an asymptomatic CIED in situ (Group 1), and 39 were studies performed in patients with symptomatic devices. Of these, 14 were subsequently deemed on follow-up to be non-infected (Group 2), and 25 confirmed as infected post-device extraction (Group 3). Ratios of maximal uptake around the CIED in both the attenuation corrected and non-attenuation corrected images were calculated to regions of normal physiological uptake, along with the maximal standardized uptake value (SUVmax) alone. Receiver operating characteristic analysis was performed for all methods at both time points. Measurement reliability was assessed using the intraclass correlation coefficient (ICC).

Results

Using Group 1 as a reference, all methods gave an area under the curve (AUC) greater than 0.93. Using Group 2 as reference, the accuracy varied greatly, with AUC values ranging from 0.71 to 0.97. The hepatic blood pool (HBP) ratio gave the highest AUC values. The calculated ICC values for each method showed the SUVmax and HBP measurement to have the greatest reliability, with values of 1.0 and 0.97, respectively.

Conclusions

Quantitation of [18F] FDG uptake was found to have a high degree of accuracy in confirming the diagnosis of CIED infection. Normalization to HBP uptake was found to give the greatest AUC and demonstrated excellent reliability. Inconsistencies from published data indicate that individual imaging centers should only use published data for guidance.

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Disclosure

The authors have indicated that they have no financial conflict of interest.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom

    Matthew J. Memmott MSc, Jacqueline James MBChB, MSc, MD, FRCP, Ian S. Armstrong MSc & Deborah Tout MSc

  2. Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom

    Fozia Ahmed MBChB, MRCP

Authors
  1. Matthew J. Memmott MSc
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  2. Jacqueline James MBChB, MSc, MD, FRCP
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  3. Ian S. Armstrong MSc
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  4. Deborah Tout MSc
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  5. Fozia Ahmed MBChB, MRCP
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Corresponding author

Correspondence to Matthew J. Memmott MSc.

Additional information

See related editorial, doi:10.1007/s12350-015-0293-2.

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Memmott, M.J., James, J., Armstrong, I.S. et al. The performance of quantitation methods in the evaluation of cardiac implantable electronic device (CIED) infection: A technical review. J. Nucl. Cardiol. 23, 1457–1466 (2016). https://doi.org/10.1007/s12350-015-0106-7

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  • DOI: https://doi.org/10.1007/s12350-015-0106-7

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