Emil Novruzov, Mardjan Dabir, Dominik Schmitt, Katalin Mattes-György, Markus Beu, Yuriko Mori, Christina Antke, Sebastian Reinartz, Artur Lichtenberg, Gerald Antoch, Frederik L Giesel, Hug Aubin, Eduards Mamlins
{"title":"使用[18F]FDG 成像诊断 LVAD 感染时，代谢容积分割与半定量 PET 参数的预测作用比较。","authors":"Emil Novruzov, Mardjan Dabir, Dominik Schmitt, Katalin Mattes-György, Markus Beu, Yuriko Mori, Christina Antke, Sebastian Reinartz, Artur Lichtenberg, Gerald Antoch, Frederik L Giesel, Hug Aubin, Eduards Mamlins","doi":"10.1007/s11307-024-01937-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Left ventricular assisting device (LVAD) is a vital mechanical circulatory assist device for patients with end-stage heart disease, serving as either a bridge to transplantation or palliative destination therapy. Yet device infection represents a major lethal complication, warranting a multi-step, complex therapy approach including an urgent device exchange or heart transplantation. Still, timely diagnosis of site and extent of VAD-specific infection for a proper therapy planning poses challenges in regular clinical care. This single-center, retrospective study aimed to evaluate the impact of volumetric PET parameters with different thresholding compared to semiquantitative PET parameters for accurate diagnosis of VAD-specific infection.</p><p><strong>Procedures: </strong>Seventeen patients (1 female, 16 males; mean age 57 ± 11 years) underwent [<sup>18</sup>F]FDG imaging for suspected VAD-specific infection between April 2013 and October 2023. Various metabolic and volumetric PET parameters with different thresholding were collected for specific LVAD components including driveline entry point, subcutaneous driveline, pump pocket, inner cannula and outflow tract. Microbiology and clinical follow-up were used as the final diagnosis standard.</p><p><strong>Results: </strong>Nine of eleven patients with VAD-specific infection underwent urgent heart transplantation, and one had a surgical revision of LVAD. Two patients had non-VAD specific infections, and two had non-VAD related infections. Metabolic burden determination using a fixed absolute threshold provided the best outcome compared to relative thresholding or other metabolic SUV parameters. The total metabolic tumor volume (MTV) cutoff value was 9.3 cm<sup>3</sup>, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.43%, 82.5%, and 0.814 (95% CI 0.555-0.958), respectively. The total lesion glycolysis (TLG) was 30.6, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.4%, 82.5%, and 0.829 (95% CI 0.571-0.964), respectively.</p><p><strong>Conclusions: </strong>Volumetric PET parameters with fixed absolute thresholding appear to be a valuable auxiliary tool in the evaluation of [<sup>18</sup>F]FDG imaging to enhance the diagnostic accuracy of VAD-specific infection.</p>","PeriodicalId":18760,"journal":{"name":"Molecular Imaging and Biology","volume":" ","pages":"812-822"},"PeriodicalIF":3.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436428/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Predictive Role of Metabolic Volume Segmentation Compared to Semiquantitative PET Parameters in Diagnosis of LVAD Infection using [<sup>18</sup>F]FDG Imaging.\",\"authors\":\"Emil Novruzov, Mardjan Dabir, Dominik Schmitt, Katalin Mattes-György, Markus Beu, Yuriko Mori, Christina Antke, Sebastian Reinartz, Artur Lichtenberg, Gerald Antoch, Frederik L Giesel, Hug Aubin, Eduards Mamlins\",\"doi\":\"10.1007/s11307-024-01937-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Left ventricular assisting device (LVAD) is a vital mechanical circulatory assist device for patients with end-stage heart disease, serving as either a bridge to transplantation or palliative destination therapy. Yet device infection represents a major lethal complication, warranting a multi-step, complex therapy approach including an urgent device exchange or heart transplantation. Still, timely diagnosis of site and extent of VAD-specific infection for a proper therapy planning poses challenges in regular clinical care. This single-center, retrospective study aimed to evaluate the impact of volumetric PET parameters with different thresholding compared to semiquantitative PET parameters for accurate diagnosis of VAD-specific infection.</p><p><strong>Procedures: </strong>Seventeen patients (1 female, 16 males; mean age 57 ± 11 years) underwent [<sup>18</sup>F]FDG imaging for suspected VAD-specific infection between April 2013 and October 2023. Various metabolic and volumetric PET parameters with different thresholding were collected for specific LVAD components including driveline entry point, subcutaneous driveline, pump pocket, inner cannula and outflow tract. Microbiology and clinical follow-up were used as the final diagnosis standard.</p><p><strong>Results: </strong>Nine of eleven patients with VAD-specific infection underwent urgent heart transplantation, and one had a surgical revision of LVAD. Two patients had non-VAD specific infections, and two had non-VAD related infections. Metabolic burden determination using a fixed absolute threshold provided the best outcome compared to relative thresholding or other metabolic SUV parameters. The total metabolic tumor volume (MTV) cutoff value was 9.3 cm<sup>3</sup>, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.43%, 82.5%, and 0.814 (95% CI 0.555-0.958), respectively. The total lesion glycolysis (TLG) was 30.6, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.4%, 82.5%, and 0.829 (95% CI 0.571-0.964), respectively.</p><p><strong>Conclusions: </strong>Volumetric PET parameters with fixed absolute thresholding appear to be a valuable auxiliary tool in the evaluation of [<sup>18</sup>F]FDG imaging to enhance the diagnostic accuracy of VAD-specific infection.</p>\",\"PeriodicalId\":18760,\"journal\":{\"name\":\"Molecular Imaging and Biology\",\"volume\":\" \",\"pages\":\"812-822\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436428/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Molecular Imaging and Biology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11307-024-01937-7\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/31 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Molecular Imaging and Biology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11307-024-01937-7","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/31 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
目的：对于终末期心脏病患者来说，左心室辅助装置（LVAD）是一种重要的机械循环辅助装置，既可作为移植的桥梁，也可作为姑息治疗的终点。然而，装置感染是一种主要的致命并发症，需要采取多步骤、复杂的治疗方法，包括紧急装置交换或心脏移植。然而，在常规临床护理中，及时诊断 VAD 感染的部位和程度以制定正确的治疗计划仍是一项挑战。这项单中心回顾性研究旨在评估不同阈值的容积 PET 参数与半定量 PET 参数相比对准确诊断 VAD 特异性感染的影响：17 名患者（1 名女性，16 名男性；平均年龄 57 ± 11 岁）在 2013 年 4 月至 2023 年 10 月期间因疑似 VAD 特异性感染接受了[18F]FDG 成像检查。针对特定的 LVAD 组件（包括动力线入口、皮下动力线、泵袋、内套管和流出道）采集了不同阈值的各种代谢和容积 PET 参数。微生物学和临床随访作为最终诊断标准：结果：在11例VAD特异性感染患者中，有9例接受了紧急心脏移植手术，1例进行了LVAD手术修补。两名患者发生了非 VAD 特异性感染，两名患者发生了与 VAD 无关的感染。与相对阈值或其他代谢 SUV 参数相比，使用固定绝对阈值确定代谢负荷的结果最好。总代谢肿瘤体积 (MTV) 临界值为 9.3 立方厘米，相应的敏感性、特异性、准确性和 AUC 分别为 90.0%、71.43%、82.5% 和 0.814（95% CI 0.555-0.958）。总病变糖酵解（TLG）为 30.6，相应的敏感性、特异性、准确性和 AUC 分别为 90.0%、71.4%、82.5% 和 0.829（95% CI 0.571-0.964）：具有固定绝对阈值的容积 PET 参数似乎是评估[18F]FDG 成像的一种有价值的辅助工具，可提高 VAD 特异性感染的诊断准确性。
The Predictive Role of Metabolic Volume Segmentation Compared to Semiquantitative PET Parameters in Diagnosis of LVAD Infection using [18F]FDG Imaging.
Purpose: Left ventricular assisting device (LVAD) is a vital mechanical circulatory assist device for patients with end-stage heart disease, serving as either a bridge to transplantation or palliative destination therapy. Yet device infection represents a major lethal complication, warranting a multi-step, complex therapy approach including an urgent device exchange or heart transplantation. Still, timely diagnosis of site and extent of VAD-specific infection for a proper therapy planning poses challenges in regular clinical care. This single-center, retrospective study aimed to evaluate the impact of volumetric PET parameters with different thresholding compared to semiquantitative PET parameters for accurate diagnosis of VAD-specific infection.
Procedures: Seventeen patients (1 female, 16 males; mean age 57 ± 11 years) underwent [18F]FDG imaging for suspected VAD-specific infection between April 2013 and October 2023. Various metabolic and volumetric PET parameters with different thresholding were collected for specific LVAD components including driveline entry point, subcutaneous driveline, pump pocket, inner cannula and outflow tract. Microbiology and clinical follow-up were used as the final diagnosis standard.
Results: Nine of eleven patients with VAD-specific infection underwent urgent heart transplantation, and one had a surgical revision of LVAD. Two patients had non-VAD specific infections, and two had non-VAD related infections. Metabolic burden determination using a fixed absolute threshold provided the best outcome compared to relative thresholding or other metabolic SUV parameters. The total metabolic tumor volume (MTV) cutoff value was 9.3 cm3, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.43%, 82.5%, and 0.814 (95% CI 0.555-0.958), respectively. The total lesion glycolysis (TLG) was 30.6, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.4%, 82.5%, and 0.829 (95% CI 0.571-0.964), respectively.
Conclusions: Volumetric PET parameters with fixed absolute thresholding appear to be a valuable auxiliary tool in the evaluation of [18F]FDG imaging to enhance the diagnostic accuracy of VAD-specific infection.
期刊介绍：
Molecular Imaging and Biology (MIB) invites original contributions (research articles, review articles, commentaries, etc.) on the utilization of molecular imaging (i.e., nuclear imaging, optical imaging, autoradiography and pathology, MRI, MPI, ultrasound imaging, radiomics/genomics etc.) to investigate questions related to biology and health. The objective of MIB is to provide a forum to the discovery of molecular mechanisms of disease through the use of imaging techniques. We aim to investigate the biological nature of disease in patients and establish new molecular imaging diagnostic and therapy procedures.
Some areas that are covered are:
Preclinical and clinical imaging of macromolecular targets (e.g., genes, receptors, enzymes) involved in significant biological processes.
The design, characterization, and study of new molecular imaging probes and contrast agents for the functional interrogation of macromolecular targets.
Development and evaluation of imaging systems including instrumentation, image reconstruction algorithms, image analysis, and display.
Development of molecular assay approaches leading to quantification of the biological information obtained in molecular imaging.
Study of in vivo animal models of disease for the development of new molecular diagnostics and therapeutics.
Extension of in vitro and in vivo discoveries using disease models, into well designed clinical research investigations.
Clinical molecular imaging involving clinical investigations, clinical trials and medical management or cost-effectiveness studies.
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