Device Infection Imaging with Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Left Ventricular Assist Device

Objective: Left ventricular assist devices (LVADs) significantly improve survival in advanced heart failure; however, infectious complications remain an important clinical challenge, with reported sepsis rates ranging from 20–40% within 1–2 years. Early and accurate identification and localization of infections—particularly at the driveline or pump—are essential for guiding treatment.

Method: We retrospectively evaluated fluorine-18 (F18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans of 15 patients with suspected LVAD infection. We assessed the presence and localization of infection (driveline vs. pump), its extent, and compared PET/CT findings with microbiological culture results.

Results: F18 FDG PET/CT demonstrated 100% sensitivity, 66% specificity, 92% positive predictive value, and 100% negative predictive value. Thirteen of 15 patients (87%) had positive PET/CT findings, with a mean SUVmax of 7.73. Infection was localized to the driveline in 10 patients and to both pump and driveline in 3. PET/CT findings were consistent with culture results, which identified Staphylococcus aureus and Pseudomonas aeruginosa as the predominant pathogens.

Conclusion: F18 FDG PET/CT is a highly sensitive, noninvasive modality for detecting and localizing LVAD infections. It aids clinicians in optimizing management strategies—such as device exchange or targeted antibiotic therapy—and may help avoid unnecessary invasive procedures. In cases of pump infection, this imaging modality supports timely interventions, including consideration for heart transplantation.

Keywords: Driveline, fluorine-18, fluorodeoxyglucose, infection, left ventricular assist device, maximum standardized uptake value, positron emission tomography/computed tomography, pump infection