Characterization of Left Ventricular Assist Device–Specific Infection by Whole-Body Parametric PET Imaging

Thorsten Derlin, Jasmin S. Hanke, Rudolf A. Werner, Sibylle I. Ziegler, Günes Dogan, Bastian Schmack, Desiree Weiberg, Christoph Czerner, Tobias L. Ross, Jan D. Schmitto, Arjang Ruhparwar, Frank M. Bengel
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Abstract

Clinical molecular imaging with PET has an evolving role in the diagnosis and treatment of left ventricular assist device (LVAD)–specific infection. We analyzed the added value of parametric whole-body [18F]FDG PET images for the multifaceted assessment of local inflammatory response to infection and characterization of systemic organ networks and explored the prognostic significance of systems-based parameters. Methods: Twenty-three patients with suspected device-specific infection were prospectively enrolled and underwent multipass [18F]FDG PET/CT with direct Patlak reconstruction between January 2020 and March 2023. Three sets of images were generated: SUV-equivalent images, parametric images of the maximum metabolic rate of [18F]FDG (MRFDG), and parametric images of the distribution volume of [18F]FDG. Images were analyzed for the presence and extent of infection, differential spatial distribution of signal in parametric images, and signal contrast. We then aimed to characterize the association between PET signal and inflammatory markers from peripheral blood, results of microbial cultures, and systemic organ networks identified in whole-body PET. Results: Visually increased uptake at the driveline exit site, subcutaneous driveline, outflow graft, and pump pocket was found in 74%, 30%, 26%, and 17% of patients, respectively, and findings were concordant between SUV images and MRFDG images. Quantitative MRFDG analysis provided accurate identification of driveline exit site infection. Improved contrast was found in MRFDG images (P ≤ 0.0003). Analysis of parametric images revealed spatial heterogeneity caused by differential contribution of MRFDG, blood volume, and distribution volume of [18F]FDG in infectious lesions. Blood-based inflammatory markers (e.g., monocyte count) (P = 0.0217) were associated with MRFDG but not SUVs. Finally, there was an association between the internal LVAD components signal and hematopoietic organ signal in MRFDG images (e.g., bone marrow signal; P = 0.0353), highlighting systemic interactions. Conclusion: [18F]FDG PET/CT allows for the diagnosis and characterization of the extent of LVAD-specific infections. Parametric MRFDG images provide improved contrast, refined biologic understanding of the relative contribution of signal components to the measured PET signal in infection, correlation with circulating immune biomarkers in peripheral blood, and characterization of systemic interactions.

通过全身参数PET成像表征左心室辅助装置特异性感染
PET临床分子成像在左室辅助装置(LVAD)特异性感染的诊断和治疗中发挥着越来越重要的作用。我们分析了参数化全身[18F]FDG PET图像在多方面评估局部感染炎症反应和表征全身器官网络方面的附加价值,并探讨了基于系统参数的预后意义。方法:前瞻性纳入23例疑似器械特异性感染的患者,于2020年1月至2023年3月进行多道[18F]FDG PET/CT直接Patlak重建。生成三组图像:suv当量图像、[18F]FDG最大代谢率参数图像(MRFDG)和[18F]FDG分布体积参数图像。分析图像感染的存在和程度,参数图像中信号的差异空间分布以及信号对比度。然后,我们的目标是表征PET信号与外周血炎症标志物、微生物培养结果和全身PET鉴定的全身器官网络之间的关系。结果:74%、30%、26%、17%的患者在动力系统出口、皮下动力系统、流出移植物和泵袋处可见视觉上的摄取增加,SUV图像与MRFDG图像的表现一致。定量MRFDG分析提供了传动系统出口部位感染的准确识别。MRFDG图像对比度提高(P≤0.0003)。参数图像分析揭示了MRFDG、血容量和[18F]FDG在感染性病变中的分布体积的不同贡献所导致的空间异质性。基于血液的炎症标志物(如单核细胞计数)(P = 0.0217)与MRFDG相关,但与suv无关。最后,MRFDG图像中LVAD内部元件信号与造血器官信号(如骨髓信号;P = 0.0353),突出了系统的相互作用。结论:[18F]FDG PET/CT可以诊断和表征lvad特异性感染的程度。参数化MRFDG图像提供了更好的对比度,改进了信号成分对感染中测量的PET信号的相对贡献的生物学理解,与外周血循环免疫生物标志物的相关性,以及系统相互作用的表征。
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