BACKGROUND Cardiac implantable electronic devices (CIEDs) chronic infection diagnosis is challenging because the clinical presentation is frequently misleading and echocardiography may be inconclusive. The aim of this study was to evaluate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and radiolabeled white blood cells single photon emission CT/CT in a cohort of patients who underwent both scans for suspicion of CIED infection and inconclusive routine investigations. METHODS Forty-eight consecutive patients with suspicion of CIED infection who underwent both 18F-fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT in a time span ≤30 days were retrospectively included. The final diagnosis of CIED infection by the endocarditis expert team was based on the modified Duke-Li classification at the end of follow-up. 18F-Fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT scans were independently analyzed blinded to the patients' medical record. RESULTS In the overall study population, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were respectively 80%, 91%, 80%, and 91% for 18F-fluorodeoxyglucose positron emission tomography/CT and 60%, 100%, 100%, and 85% for white blood cell single photon emission CT/CT. Addition of a positive nuclear imaging scan as a major criterion markedly improved the Duke-Li classification at admission. Semiquantitative parameters did not allow to discriminate between definite and rejected CIED infection. Prolonged antibiotic therapy before imaging tended to decrease the sensitivity for both techniques. CONCLUSIONS Nuclear imaging can improve the diagnostic performances of the Duke-Li score at admission in a selected population of patients with suspected CIED infection, particularly when the infection was initially graded as possible. Whenever possible, imaging should be performed before or early after antibiotic initiation.

中文翻译：

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18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描和白细胞SPECT /计算机断层扫描对可疑心脏植入式电子设备慢性感染患者的诊断影响。

背景技术心脏植入式电子设备（CIED）的慢性感染诊断具有挑战性，因为临床表现常常会产生误导，而超声心动图可能尚无定论。这项研究的目的是评估18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（CT）和放射性标记的白细胞单光子发射CT / CT对一组同时进行了CIED感染和疑似扫描的患者的诊断价值。尚无定论的常规调查。方法回顾性分析了连续怀疑48例连续30天内接受18F-氟脱氧葡萄糖正电子发射断层扫描/ CT和白细胞单光子发射CT / CT的CIED感染患者。心内膜炎专家小组对CIED感染的最终诊断是基于随访结束时改良的Duke-Li分类。对18F-氟脱氧葡萄糖正电子发射断层扫描/ CT和白细胞单光子发射CT / CT扫描进行了独立分析，不了解患者的病历。结果在整个研究人群中，18F-氟脱氧葡萄糖正电子发射断层扫描/ CT的诊断敏感性，特异性，阳性预测值和阴性预测值分别为80％，91％，80％和91％，以及60％，100％ ，100％和85％用于白细胞单光子发射CT / CT。添加阳性核成像扫描作为主要标准显着改善了入院时的Duke-Li分类。半定量参数无法区分明确的和拒绝的CIED感染。成像前延长抗生素治疗往往会降低两种技术的敏感性。结论核显像可以改善入选特定CIED感染患者的入院时Duke-Li评分的诊断性能，尤其是在最初对感染进行分级时。在可能的情况下，应在开始抗生素治疗之前或之后进行影像学检查。特别是在最初对感染进行分级时。在可能的情况下，应在开始抗生素治疗之前或之后进行影像学检查。特别是在最初对感染进行分级时。在可能的情况下，应在开始抗生素治疗之前或之后进行影像学检查。