9-08: Comparison of trans-esophageal echocardiography and FDG PET/CT in the diagnosis of implanted device lead endocarditis

Abstract

Introduction: 18-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) scan has been proposed as a diagnostic tool for cardiac implantable electronic device (CIED) infection. We investigated the role of FDG PET/CT for the diagnosis of lead endocarditis as compared to conventional trans-esophageal echocardiography (TEE). Method(s): Patients with a confirmed diagnosis of lead endocarditis (positive lead culture after extraction of the suspected CIED) were included in the study. A TEE and a FDG PET/CT scan were performed before extraction and each analyzed blindly to assess for the presence of a lead infection (vegetation and FDG uptake along the device leads). Result(s): 41 consecutive pts (73 +/-13 years, 36 male) were studied. At the time of imaging 59% of pts were on antibiotics. TEE identified a lead vegetation in 12 pts (29%); they ranged 2 to 20 mm in size. On FDG PET/CT there was increased uptake along the lead in 33 pts (80%), and along the intra-cardiac portion of the device in 22 pts (54%). Of the 22 patients with a positive intra-cardiac portion on PET/CT, 16 (73%) did not demonstrate a vegetation on TEE. On PET/CT there was increased uptake along the extra-cardiac portion of the lead in 30 pts (73%). When used together, TEE or PET/ CT scan identified 38 pts (93%) with lead endocarditis. With PET/CT septic emboli were identified in 9 pts (22%): 4 with spondylodiscitis, 4 with septic pulmonary emboli and 1 with an infected vascular prosthesis. Conclusion(s): Compared to PET/CT, TEE is less sensitive in detecting implanted lead endocarditis. When used synergistically with TEE it confers higher sensitivity of detecting lead infections, including extra-cardiac involvement. (Figure Presented).