Positron Emission Tomography/Computed Tomography Imaging in Device Infective Endocarditis

Lancellotti, Patrizio; Habib, Gilbert; Oury, Cécile; Nchimi, Alain

doi:10.1161/circulationaha.115.018521

Cited by 23 publications

(13 citation statements)

References 20 publications

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“…21 Hence, although echocardiography will remain an invaluable first-line tool, complementary molecular imaging techniques may be of increasing value, especially in doubtful cases which were the focus of the present study. Besides conventional WBC scintigraphy, 18 F-FDG PET/CT has been increasingly recognized as a valuable tool in endocarditis, 22 and ESC guidelines recommend both tests in suspected but unconfirmed prosthetic valve infection. 3 Compared with FDG PET, WBC scintigraphy is thought to have lower sensitivity (owing to lower camera resolution and detection sensitivity) but higher specificity for endocarditis (owing to the more direct correlation of WBC infiltration to infection vs. the sometimes non-specific uptake of 18 F-FDG).…”

Section: Discussionmentioning

confidence: 99%

Simultaneous dual-isotope solid-state detector SPECT for improved tracking of white blood cells in suspected endocarditis

et al. 2016

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AimsHigh-energy resolution and sensitivity of novel cadmium-zinc-telluride (CZT) detector equipped SPECT systems facilitate simultaneous imaging of multiple isotopes and may enhance the detection of molecular/cellular signals. This may refine the detection of endocarditis. This study was designed to determine the feasibility and diagnostic accuracy of simultaneous imaging of inflammation with 111 In-labeled white blood cells (WBCs) and myocardial perfusion with 99m Tc-sestamibi, for localization of WBCs relative to the valve plane in suspected endocarditis. Methods and resultsA dedicated cardiac CZT camera (Discovery 530c, GE Healthcare) was employed. Anthropomorphic thorax phantom studies were followed by clinical studies in 34 patients with suspected infection of native valves (n ¼ 12) or implants (n ¼ 22 In activity as high as 2.5* 99m Tc activity. In patients, image quality was superior for CZT imaging vs. conventional SPECT-CT and planar scintigraphy (P , 0.01). Cadmium-zinc-telluride dual isotope imaging improved reader confidence for detection of inflammatory foci. Diagnostic accuracy based on surgery or Duke Criteria during follow-up was highest for CZT imaging (P , 0.001). ConclusionNovel CZT SPECT technology improves the accuracy of molecular/cellular cardiac imaging. Simultaneous multi-isotope imaging with 111 In and 99m Tc is feasible and aids in the workup of suspected endocarditis.--

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Section: Discussionmentioning

confidence: 99%

Simultaneous dual-isotope solid-state detector SPECT for improved tracking of white blood cells in suspected endocarditis

et al. 2016

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“…Combining FDG-PET/CT with the Modified Duke Criteria resulted in increased sensitivity with no major change in specificity [46••]. Whereas FDG-PET is unreliable in the setting of native valve endocarditis [47•], it accurately diagnoses prosthetic valve endocarditis and systemic complications of IE [47•–54]. Acknowledging this utility, in 2015 FDG-PET/CT was included in the guidelines of the European Society of Cardiology as a major criterion for diagnosing IE in patients with prosthetic valves [55•].…”

Section: Endocarditismentioning

confidence: 99%

Novel Noninvasive Nuclear Medicine Imaging Techniques for Cardiac Inflammation

Kircher

Lapa

2017

Curr Cardiovasc Imaging Rep

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Purpose of ReviewInflammation is a key player in a wide range of cardiovascular and myocardial diseases. Given the numerous implications of inflammatory processes in disease initiation and progression, functional imaging modalities including positron emission tomography (PET) represent valuable diagnostic, prognostic, and monitoring tools in patient management. Since increased glucose metabolism is a hallmark of inflammation, PET using the radiolabeled glucose analog [18F]-2-deoxy-2-fluoro-d-glucose (FDG) is the mainstay diagnostic test for nuclear imaging of (cardiac) inflammation. Recently, new approaches using more specific tracers to overcome the limited specificity of FDG have emerged.Recent FindingsPET imaging has proven its value in a number of inflammatory conditions of the heart including myocarditis, endocarditis, sarcoidosis, or reactive changes after myocardial infarction. In infection-related endocarditis, FDG-PET and white blood cell scintigraphy have been implemented in current guidelines. FDG-PET is considered as nuclear medical gold standard in myocarditis, pericarditis, or sarcoidosis. Novel strategies, including targeting of somatostatin receptors or C-X-C motif chemokine receptor CXCR4, have shown promising results in first studies.SummaryNuclear medicine techniques offer valuable information in the assessment of myocardial inflammation. Given the possibility to directly visualize inflammatory activity, they represent useful tools for diagnosis, risk stratification, and therapy monitoring.

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“…12 A non-invasive test with sufficient sensitivity and specificity to confirm or exclude infection in cases with a low-intermediate pre-test probability of infection at initial presentation would be valuable. Traditional management of CIED infection is reactive.…”

Section: Implications On Clinical Practicementioning

confidence: 99%

“…10,11 One particular shortcoming of the Modified Duke Criteria in suspected CIED-LI and PVE is that a significant proportion of patients remain categorized as ''possible endocarditis,'' which only perpetuates diagnostic uncertainty in already challenging cases. 12,13 In view of these limitations, there has been a drive to develop novel imaging strategies specific to cardiovascular device infection. 14 In this issue of Journal of Nuclear Cardiology, Mahmood et al report results from a meta-analysis of 14 recent studies evaluating the diagnostic accuracy of 18 F-FDG PET/CT for suspected CIED infection across the full spectrum of clinical presentations.…”

mentioning

confidence: 99%

18F-FDG PET/CT now endorsed by guidelines across all types of CIED infection: Evidence limited but growing

Ahmed

Arumugam

2019

Journal of Nuclear Cardiology

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Positron Emission Tomography/Computed Tomography Imaging in Device Infective Endocarditis

Cited by 23 publications

References 20 publications

Simultaneous dual-isotope solid-state detector SPECT for improved tracking of white blood cells in suspected endocarditis

Simultaneous dual-isotope solid-state detector SPECT for improved tracking of white blood cells in suspected endocarditis

Novel Noninvasive Nuclear Medicine Imaging Techniques for Cardiac Inflammation

18F-FDG PET/CT now endorsed by guidelines across all types of CIED infection: Evidence limited but growing

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