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The study prospectively evaluated the usefulness of FDG PET/CT for the diagnosis of device infection in 21 patients with clinically suspected device infection, and 14 controls free of infection. Compared to the gold standard of device culture after extraction or clinical follow-up, FDG PET/CT showed a high sensitivity and specificity for diagnosis of device infection, superior for pocket infection than lead infection evaluation
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may play a critical role in difficult cases. The study showed the potential value of FDG-PET/CT scanning in the diagnosis of pacing lead endocarditis in 10 difficult cases with absence of valvular or lead vegetations on transthoracic and transesophageal echocardiography. FDG PET/CTshowed lead infection in 6 cases which were confirmed on subsequent culture of lead after extraction. In the 4 cases with a negative FDG PET/CT scan, the pacing system was left in place without objective signs of active lead endocarditis during follow-up. The study showed that FDG PET/CT may guide the clinical decision making for difficult cases with clinically suspected cardiac device infection
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.• Ploux S, Riviere A, Amraoui S, et al. Positron emission tomography in patients with suspected pacing system infections may play a critical role in difficult cases. Heart Rhythm. 2011;8:1478-81. The study showed the potential value of FDG-PET/CT scanning in the diagnosis of pacing lead endocarditis in 10 difficult cases with absence of valvular or lead vegetations on transthoracic and transesophageal echocardiography. FDG PET/CTshowed lead infection in 6 cases which were confirmed on subsequent culture of lead after extraction. In the 4 cases with a negative FDG PET/CT scan, the pacing system was left in place without objective signs of active lead endocarditis during follow-up. The study showed that FDG PET/CT may guide the clinical decision making for difficult cases with clinically suspected cardiac device infection.
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The study first showed that FDG PET/CT can differentiate device infection from recent post-implant inflammation changes. FDG PET/CT findings can guide clinical management of infected cases by localizing the infection sites of superficial or deep pocket infection
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The study prospectively studied 72 consecutive patients suspected of having prosthesis valve endocarditis. The results showed that FDG PET/CT can detect prosthesis valve infection earlier than the echocardiography with a high sensitivity and specificity. Inclusion of abnormal FDG uptake at the site of the prosthetic valve, as a novel major criterion, can significantly increase the sensitivity of the modified Duke criteria, without compromising specificity
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doi:10.1016/j.jcmg. 2013.07.004. This was an "iPix-Imaging Vignette" in the journal with typical images showing that FDG PET/CTcould provide unique and incremental information over echocardiography and CTA in diagnosing prosthesis valve endocarditis and its complication of peri-annular abscess. Meanwhile, FDG PET/CT could confirm the diagnosis of infection by echocardiography and CTA, but provide additional information of extra-cardiac infection sites
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.• Tanis W, Scholtens A, Habets J, et al. Fusion of Cardiac Computed Tomography Angiography and 18 F-Fluorodesoxyglucose Positron Emission Tomography for the Detection of Prosthetic Heart Valve Endocarditis. J Am Coll Cardiol Imaging. 2013. doi:10.1016/j.jcmg. 2013.07.004. This was an "iPix-Imaging Vignette" in the journal with typical images showing that FDG PET/CTcould provide unique and incremental information over echocardiography and CTA in diagnosing prosthesis valve endocarditis and its complication of peri-annular abscess. Meanwhile, FDG PET/CT could confirm the diagnosis of infection by echocardiography and CTA, but provide additional information of extra-cardiac infection sites.
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J Am Coll Cardiol Imaging
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Tanis, W.1
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On Adding Versus Selecting Imaging Modalities for Incremental Diagnosis: A Case-Study of 18 F-Fluorodeoxyglucose PET/CT in Prosthetic Valve Endocarditis
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