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.