Cardiac multidetector computed tomography in infective endocarditis: a pictorial essay

Grob, Anaïs; Thuny, Franck; Villacampa, Chloe; Flavian, Antonin; Gaubert, J.; Raoult, Didier; Casalta, Jean‐Paul; Habib, Gilbert; Moulin, G.; Jacquier, Alexis

doi:10.1007/s13244-014-0353-1

Cited by 46 publications

(58 citation statements)

References 28 publications

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“…Angio‐CT and magnetic resonance imaging (MRI) have been recommended as useful approaches to rule out the IIA. However, conventional angiography is still the gold standard for definitive imaging in patients with IE . Our practice has evolved over time to liberal screening with CT scans of the chest, abdomen, and brain in IE patients requiring surgery.…”

Section: Discussionmentioning

confidence: 99%

Management of Septic emboli in patients with infectious endocarditis

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Management of Septic emboli in patients with infectious endocarditis

et al. 2017

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“…In previous studies, a vegetation length >10 mm, pedunculated, and mobility were predictors for the embolism (31,32). A differential diagnosis for vegetation generally requires differentiation between a thrombus and fibroelastoma (33).…”

Section: Detecting Of Primary Cardiac Tumorsmentioning

confidence: 85%

Differentiation of Primary Cardiac Tumors from Metastatic Tumors by Non-invasive Cardiac Imaging

Otomi

Otsuka

Arase

et al. 2018

Annals of Nuclear Cardiology

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Background: Various imaging modalities are used to identify and characterize cardiac masses. While echocardiography remains the preferred imaging modality to evaluate cardiac masses, computed tomography (CT), magnetic resonance imaging (MRI), and 18 F-fluorodeoxyglucose positron emission tomography (18 F-FDG PET)/CT are being increasingly employed to assess cardiac mass lesions. However, the clinical value of noninvasive cardiac imaging for differentiating between primary cardiac mass and metastatic lesions has not yet been examined in detail. The purpose of the present study was to evaluate the diagnostic utility of non-invasive cardiac imaging for differentiating primary cardiac tumors from metastatic lesions, and non-tumorous lesions. Methods: A retrospective review was conducted on 22 cardiac mass lesions in 20 patients assessed by cardiac imaging (at least one of CT, MRI, or 18 F-FDG PET/CT) between December 2005 and March 2017. CT findings included the tumor size, location, existence of calcification, and morphology of the base portion of the lesion. MRI parameters included signals with T1-weighted imaging (T1WI), T2WI, mobility with cine imaging, and contrast enhancement. Tracer uptake by each cardiac lesion using 18 F-FDG PET/CT was also evaluated. Results: Among 17 cardiac mass lesions assessed by contrast-enhanced CT, all cardiac myxomas and papillary fibroelastomas had a pedunculated base portion. All metastases located in the cavity had a sessile base portion (P=0.0035). Malignant tumors (metastases and malignant lymphoma) had no mobility, while cardiac myxomas had a slightly higher frequency of mobility with cine MRI (0% vs. 100%, P=0.0667). Among the four lesions for which 18 F-FDG PET/CT was performed, the three malignant lesions had strong 18 F-FDG uptake, while the benign lesion showed insignificant accumulation. Conclusions: The characteristics of the base portion of cardiac mass were useful for differentiating primary cardiac tumors from metastatic cardiac tumors. Cine MRI also exhibited diagnostic utility for differentiating between primary cardiac tumors and metastases. Therefore, non-invasive cardiac imaging may be employed to differentiate cardiac mass lesions. The accurate diagnosis of cardiac mass lesions may require the assessment of multiple characteristics on images.

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“…However, TEE may miss up to 30% of valvular prosthetic endocarditis because of the underlying metal ring-related acoustic shadowing artifact (11). Cardiac CT/ CTA is a modality of choice for assessing perivalvular complications with a high sensitivity, better than TEE (12). However, both modalities detect late morphologic changes of infection, and findings are often nonspecific and associated with artifacts from the device's foreign material components.…”

Section: Anatomic Imaging Toolsmentioning

confidence: 99%

Molecular Imaging of Cardiovascular Device Infection: Targeting the Bacteria or the Host–Pathogen Immune Response?

Chen¹,

Dilsizian²

2020

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to (1) understand the role of 18 F-FDG PET/CT for diagnosis of cardiovascular device infection, as a functional imaging tool for assessing the overall host-pathogen immune response in infection; (2) learn about the strengths and limitations of bacteria-targeting radiotracers for infection imaging, including those based on substances of bacterial maltodextrin transporters, bacterial thymidine kinase, antibiotics, antimicrobial peptides, antibacterial antibodies, bacteriophages, and bacterial DNA/RNA hybrid nucleotide oligomers; and (3) discuss the pros and cons of 18 F-FDG versus bacteria-targeting tracers. Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through March 2023. Rapid and accurate diagnosis of cardiovascular device infection remains a challenge in the clinic. Anatomic imaging tools such as echocardiography and cardiac CT or CT angiography are the firstline modalities for clinically suspected endocarditis given their ability to detect vegetation and perivalvular complications. Accumulating data suggest that functional imaging with 18 F-FDG PET/CT has unique merits over anatomic imaging and could potentially diagnose early cardiac device infection before morphologic damage ensues and identify infection sources or bacterial emboli in the rest of the body. Although an abnormal finding on 18 F-FDG PET/CT was added to the 2015 guidelines of the European Society of Cardiology as a major criterion for the diagnosis of device-related and prosthetic valve endocarditis, that addition has not been incorporated in the U.S. guidelines. Beyond these clinically available imaging tools, attempts have been made to develop bacteria-targeting tracers for specific infection imaging, which include tracers of bacterial maltodextrin transporter, bacterial thymidine kinase, antibiotics, antimicrobial peptides, bacterial antibodies, bacteriophages, and bacterial DNA/RNA hybrid nucleotide oligomers. Most of the tracers have been studied only in experimental animals, except for radiolabeled antibiotics, which have been examined in humans without success in clinical translation for infection imaging. In this article, we compare the roles of anatomic and functional imaging for cardiac device infection and discuss the pros and cons of 18 F-FDG and bacteria-targeting tracers. While anticipating continued investigations for bacteria-specific...

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Cardiac multidetector computed tomography in infective endocarditis: a pictorial essay

Cited by 46 publications

References 28 publications

Management of Septic emboli in patients with infectious endocarditis

Management of Septic emboli in patients with infectious endocarditis

Differentiation of Primary Cardiac Tumors from Metastatic Tumors by Non-invasive Cardiac Imaging

Molecular Imaging of Cardiovascular Device Infection: Targeting the Bacteria or the Host–Pathogen Immune Response?

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