晩期感染が疑われる心臓埋め込み型電子機器患者におけるF-FDG PET/CTの有用性

Usefulness of F-FDG PET/CT in Patients with Cardiac Implantable Electronic Device Suspected of Late Infection.

• Giuseppe Rubini
• Cristina Ferrari
• Domenico Carretta
• Luigi Santacroce
• Rossella Ruta
• Francesca Iuele
• Valentina Lavelli
• Nunzio Merenda
• Carlo D'Agostino
• Angela Sardaro
• Artor Niccoli Asabella

抄録

心血管植込み型電子機器（CIED）の存在は，重大な罹患率や死亡率を伴う晩期感染などの合併症の負担となり，早急かつ効果的な治療が必要となる．本研究の目的は，CIED感染が疑われる患者におけるF-FDG PET/CT（F-Fluorodeoxyglucose positron-emission tomography/computed tomography）の役割を評価することであった．CIED感染の疑いでF-FDG PET/CTを施行した患者15例をレトロスペクティブに解析した。また、CIEDを有し、腫瘍学的な理由でF-FDG PET/CTを施行した患者15例についても評価した。視覚的定性分析と半定量分析を行った。すべての患者は、F-FDG PET/CTの結果にかかわらず、標準的な臨床管理を受けていた。感度、特異度、精度、陽性予測値（PPV）、陰性予測値（NPV）は、それぞれ90.91％、75％、86.67％、90.91％、75％であった。最大標準化取り込み値（SUV）と半定量比（SQR）を収集し、CIED感染者と非感染者の間で統計学的に有意な差を示した。探索的カットオフ値はSUV（2.56）とSQR（4.15）のROC（受信操作特性）曲線から導出された。本研究は，CIED感染患者におけるF-FDG PET/CTの感度，再現性，非侵襲性の高さから，臨床的有用性を示唆するものである．特に臨床症状が疑わしい患者では、臨床家の意思決定に役立つと思われる。今後、F-FDG PET/CTの性能に関する正確なプロトコルを確立するために、大規模かつ多中心的な研究が行われるべきである。

The presence of a cardiovascular implantable electronic device (CIED) can be burdened by complications such as late infections that are associated with significant morbidity and mortality and require immediate and effective treatment. The aim of this study was to evaluate the role of F-fluorodeoxyglucose positron-emission tomography/computed tomography (F-FDG PET/CT) in patients with suspected CIED infection. Fifteen patients who performed a F-FDG PET/CT for suspicion of CIED infection were retrospectively analyzed; 15 patients, with CIED, that underwent F-FDG PET/CT for oncological reasons, were also evaluated. Visual qualitative analysis and semi-quantitative analysis were performed. All patients underwent standard clinical management regardless F-FDG PET/CT results. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) resulted as 90.91%, 75%, 86.67%, 90.91% and 75% respectively. Maximum standardized uptake values (SUV) and semi-quantitative ratio (SQR) were collected and showed differences statistically significant between CIED infected patients and those who were not. Exploratory cut-off values were derived from receiver operating characteristic (ROC) curves for SUV (2.56) and SQR (4.15). This study suggests the clinical usefulness of F-FDG PET/CT in patients with CIED infection due to its high sensitivity, repeatability and non-invasiveness. It can help the clinicians in decision making, especially in patients with doubtful clinical presentation. Future large-scale and multicentric studies should be conducted to establish precise protocols about F-FDG PET/CT performance.