Paola A Erba1, Martina Sollini2, Umberto Conti3, Francesco Bandera3, Carlo Tascini4, Salvatore M De Tommasi3, Giulio Zucchelli3, Roberta Doria4, Francesco Menichetti4, Maria Grazia Bongiorni3, Elena Lazzeri5, Giuliano Mariani5. 1. Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy. Electronic address: p.erba@med.unipi.it. 2. Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy. 3. Division of Cardiology, University Hospital of Pisa, Pisa, Italy. 4. Division of Infectious Diseases, University Hospital of Pisa, Pisa, Italy. 5. Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy.
Abstract
OBJECTIVES: The aim of this study was to investigate the diagnostic performance of (99m)Tc-hexamethypropylene amine oxime labeled autologous white blood cell ((99m)Tc-HMPAO-WBC) scintigraphy in patients with suspected infections associated with cardiovascular implantable electronic devices (CIEDs). BACKGROUND: Early, definite recognition of CIED-related infections combined with accurate localization and quantification of disease burden is a prerequisite for optimal treatment strategies. METHODS: All 63 consecutive patients underwent clinical examination, blood chemistry, microbiology, and echography of the cardiac region/venous pathway of the device. Final diagnosis of infection was established in 32 of 63 patients and in 23 of 32 by microbiology. RESULTS: Sensitivity of (99m)Tc-HMPAO-WBC single-photon emission computed tomography/computed tomography (SPECT/CT) was 94% for both detection and localization of CIED-associated infection. SPECT/CT imaging had a definite added diagnostic value over both planar and stand-alone SPECT. Pocket infection was often associated with lead(s) involvement; the intracardiac portion of the lead(s) more frequently exhibited (99m)Tc-HMPAO-WBC accumulation and presented the highest rate of complications, infectious endocarditis, and septic embolism. Two false negative cases and no false positive results were observed. None of the patients with negative (99m)Tc-HMPAO-WBC scintigraphy developed CIED-related infection during follow-up of 12 months. Echography of the cardiac region/venous pathway of the device had 90% specificity, but low sensitivity (81% when intracardiac lead[s] infection only was considered). The Duke criteria had 31% sensitivity for the definite category (100% specificity) and 81% for the definite and possible categories (77% specificity). CONCLUSIONS: (99m)Tc-HMPAO-WBC scintigraphy enabled the confirmation of the presence of CIED-associated infection, definition of the extent of device involvement, and detection of associated complications. Moreover, (99m)Tc-HMPAO-WBC scintigraphy reliably excluded device-associated infection during a febrile episode and sepsis, with 95% negative predictive value.
OBJECTIVES: The aim of this study was to investigate the diagnostic performance of (99m)Tc-hexamethypropylene amine oxime labeled autologous white blood cell ((99m)Tc-HMPAO-WBC) scintigraphy in patients with suspected infections associated with cardiovascular implantable electronic devices (CIEDs). BACKGROUND: Early, definite recognition of CIED-related infections combined with accurate localization and quantification of disease burden is a prerequisite for optimal treatment strategies. METHODS: All 63 consecutive patients underwent clinical examination, blood chemistry, microbiology, and echography of the cardiac region/venous pathway of the device. Final diagnosis of infection was established in 32 of 63 patients and in 23 of 32 by microbiology. RESULTS: Sensitivity of (99m)Tc-HMPAO-WBC single-photon emission computed tomography/computed tomography (SPECT/CT) was 94% for both detection and localization of CIED-associated infection. SPECT/CT imaging had a definite added diagnostic value over both planar and stand-alone SPECT. Pocket infection was often associated with lead(s) involvement; the intracardiac portion of the lead(s) more frequently exhibited (99m)Tc-HMPAO-WBC accumulation and presented the highest rate of complications, infectious endocarditis, and septic embolism. Two false negative cases and no false positive results were observed. None of the patients with negative (99m)Tc-HMPAO-WBC scintigraphy developed CIED-related infection during follow-up of 12 months. Echography of the cardiac region/venous pathway of the device had 90% specificity, but low sensitivity (81% when intracardiac lead[s] infection only was considered). The Duke criteria had 31% sensitivity for the definite category (100% specificity) and 81% for the definite and possible categories (77% specificity). CONCLUSIONS: (99m)Tc-HMPAO-WBC scintigraphy enabled the confirmation of the presence of CIED-associated infection, definition of the extent of device involvement, and detection of associated complications. Moreover, (99m)Tc-HMPAO-WBC scintigraphy reliably excluded device-associated infection during a febrile episode and sepsis, with 95% negative predictive value.
Authors: Paola Anna Erba; Patrizio Lancellotti; Isidre Vilacosta; Oliver Gaemperli; Francois Rouzet; Marcus Hacker; Alberto Signore; Riemer H J A Slart; Gilbert Habib Journal: Eur J Nucl Med Mol Imaging Date: 2018-05-24 Impact factor: 9.236
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Authors: Zaid I Almarzooq; Anubodh S Varshney; Muthiah Vaduganathan; Manan Pareek; Garrick C Stewart; Jerry D Estep; Mandeep R Mehra Journal: JACC Cardiovasc Imaging Date: 2019-09-18