Diagnosing Left Ventricular Assist Device Infection Using [ 18 F]Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: Central Versus Peripheral Patterns and Bloodstream Infection Risk.

Diagnosing infections related to left ventricular assist devices (LVADs) is challenging due to poor accessibility and imaging artifacts, particularly when central components are involved. We investigated whether fluorine-18 fluorodeoxyglucose ([ 18 F]FDG) positron emission tomography/computed tomography (PET/CT) improves the diagnosis of bloodstream infection (BSI) compared with clinical parameters alone. Sixty-one patients with suspected LVAD infection underwent PET/CT between 2016 and 2022. Fluorodeoxyglucose uptake at the LVAD exit site, driveline, inflow/outflow cannulas, and pump according to Deauville score (DS) and lymphadenopathy were assessed. C-reactive protein (CRP), body temperature, white blood cell count (WBC), and bloodstream infection (BSI) (positive blood cultures obtained within ±7 days) were documented. Overall, 52% of patients were BSI-positive; clinical parameters were not consistently correlated with DS. Sensitivity for detecting BSI was highest for CRP greater than 0.5 mg/dl (69%, 95% confidence interval [CI]: 50-84) and specificity for WBC (75%, 56-90). Positron emission tomography/computed tomography-based DS greater than or equal to 4 of peripheral components had less than 50% sensitivity and only modest specificity. Diagnostic performance was better for central components with the highest sensitivities for pump and outflow cannula (79%, 41-95; 77%, 56-91) and highest specificity for inflow cannula (85%, 55-98) in conjunction with positive lymphadenopathy (96%, 77-100). Combined with lymphadenopathy, PET/CT-based DS of central LVAD components outperforms standard clinical parameters in detecting LVAD-related BSI, thereby supporting an individualized therapeutic approach.