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DOI: 10.1055/s-0036-1571747
The Value of PET-CT Scans in Patients with Ventricular Assist Devices
Background: Infections are major complications in patients with ventricular assist devices (VAD) and reasons for high urgency listing for transplantation. Whereas results after transplantation are comparable in patients with and without driveline infections (DI), large registry results showed that the mortality is higher in those with a device infection or mediastinitis. Positron emission tomography-computed tomography (PET-CT) is a diagnostic tool to scan for tissue with high metabolism like in infections. The specificity of PET-CT to discriminate between infection and high metabolism due to an aseptic reaction to the device is not clear.
Methods: Until September 2015 a total number of 100 patients underwent VAD implantations an our institution. 23 patients (mean age: 54.3 ± 4.9 years) underwent PET-CT scans for a suspected infection. 9 patients had two PET-CT scans at different time points. All radiologic results were compared with clinical and intraoperative parameters.
Results: In six patients with elevated laboratory findings, PET-CT scan ruled out any VAD related infections and during three months of follow-up these patients experienced no clinical signs of an infection leading to no further treatment. In 17 patients, the positive PET-CT results correlated with laboratory, clinical and intraoperative signs of an infection. All patients with positive PET-CT scans were treated by iv-antibiotics. Nine patients had DI confirmed by local inflammation and were treated by antibiotics alone, four patients had an impaired wound healing with and without mediastinitis treated by VAC therapy, four patients had device infections, two with and two without DI. The PET-CT was able to show the device infection at an early stage. The positive findings for device infection were first undervalued, but later on confirmed intraoperatively. In nine patients who had two PET-CT scans at different time points the results correlated with clinical improvement of the infection.
Conclusion: PET-CT scan showed a high correlation with clinical parameters and was specific for infection. Therefore, it may have the potential to guide the clinician in correct handling of infectious complications after VAD implantation.