Comparaison des performances diagnostiques de la TEP-TDM au 18F FDG et de la scintigraphie aux leucocytes marqués dans les infections de dispositifs d’assistance ventriculaire gauche

Abstract : Abstract: background The usage of left-ventricular-assist-device (LVAD) is increasing in patients with advanced heart failure. However, device-related infections are a challenge to recognize and to treat, with an important morbidity and mortality rate. The role of nuclear medicine imaging remains not well established for LVAD infections. The present study compared the accuracy of positron emission tomography/computed tomography with 18F-fludeoxyglucose (18F-FDG PET/CT) and radiolabeled leucocyte scintigraphy for the diagnosis of infections in patients supported with a continuous-flow LVAD. Methods: from a prospectively maintained database, we retrospectively analyzed the diagnostic performance of radiolabeled leucocyte scintigraphy and 18F-FDG PET/CT in 24 patients who had a LVAD with a suspected device-related infection. Both examinations were routinely performed in all patients. Infection was assessed by the ISHLT criteria. Results: twenty-four patients were included, 15 had a specific VAD infection (5 cardiac-LVAD and 10 driveline), 6 had a VAD-related infection, while 3 patients had a non-VAD-related infection. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.2 %, 66.7 %, 95.2 %, 66.7 %, and 91.6 %, respectively, for 18F-FDG-PET and 71.4 %, 100 %, 100 %, 33.3 %, and 75 %, respectively, for leucocyte scintigraphy. 18F-FDG PET/CT showed significantly higher sensitivity (p=0.01) than leucocyte scintigraphy. Conclusion: 18F-FDG PET/CT and radiolabeled leucocyte scintigraphy SPECT carry high performance in the diagnostic of LVAD infections. 18F-FDG PET/CT shows significantly higher sensitivity and could be proposed as first-line nuclear medicine procedure.
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Master Thesis
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Submitted on : Wednesday, January 9, 2019 - 3:38:51 PM
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Carole de Vaugelade Du Breuillac. Comparaison des performances diagnostiques de la TEP-TDM au 18F FDG et de la scintigraphie aux leucocytes marqués dans les infections de dispositifs d’assistance ventriculaire gauche. Médecine humaine et pathologie. 2018. ⟨dumas-01975810⟩

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