Device Infection Imaging with F18 FDG-PET/CT in Patients with Left Ventricular Assist Device

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

METHOD
We retrospectively evaluated F18 FDG PET/CT scans of 15 patients with suspected LVAD infection. We assessed infection presence, localization (driveline vs. pump), extent, and compared PET/CT findings with microbiological culture results.

RESULTS
F18 FDG PET/CT achieved 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 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 supports timely interventions, including consideration for heart transplantation.