Possible role of F18-FDG-PET/CT in the diagnosis of endocarditis: preliminary evidence from a review of the literature

Bertagna, Francesco; Bisleri, Gianluigi; Motta, Federica; Merli, Giuseppe; Cossalter, Erika; Lucchini, Silvia; Biasiotto, Giorgio; Bosio, Giovanni; Terzi, Arturo; Muneretto, Claudio; Giubbini, Raffaele

doi:10.1007/s10554-011-9984-1

Cited by 36 publications

(18 citation statements)

References 58 publications

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“…The role of FDG-PET/CT in the diagnosis of valvular endocarditis has been suggested by several small studies and sporadic case reports; however, with some controversy [15][16][17][18][19][20][21]. This controversy most probably derives from the lack of a standardized protocol for myocardium imaging with FDG-PET/CT.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have demonstrated the role of FDG-PET/CT in detecting infections of vascular prostheses [8][9][10] and implantable pacemakers/ defibrillators [11][12][13][14]. Furthermore, an important role of FDG-PET/CT in the diagnosis of IE has been proposed by several recent publications [15][16][17][18][19][20][21]. Few data regarding the diagnosis of ECC by FDG-PET/CT exist [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis

Orvin

Goldberg

Bernstine

et al. 2015

Clinical Microbiology and Infection

112

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The exact incidence of extra-cardiac complications (ECC) in patients with infective endocarditis (IE) is unknown but presumed to be high. These patients, although mostly asymptomatic, may require a more aggressive therapeutic approach. (18)fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used for the diagnosis of infections, but its role in the early diagnosis of IE complications is still unclear. This study aimed to evaluate the role of FDG-PET/CT in the early diagnosis of ECC in IE and its implications for medical management. We prospectively studied 40 consecutive patients with a confirmed diagnosis of IE (according to the modified Duke criteria) who underwent a whole body FDG-PET/CT study within 14 days from diagnosis. The FDG-PET/CT demonstrated ECC in 17 (42.5%) patients, while 8 (38.1%) of them were asymptomatic. The most frequent embolic sites were musculoskeletal and splenic. Owing to the FDG-PET/CT findings, treatment planning was modified in 14 (35%) patients. This included antibiotic treatment prolongation (27.5%), referral to surgical procedures (15%) and, most substantially, prevention of unnecessary device extraction (17.7%). According to our experiences, FDG-PET/CT imaging was useful in the detection of embolic and metastatic infections in IE. This clinical information had a significant diagnostic and therapeutic impact in managing IE disease.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis

Orvin

Goldberg

Bernstine

et al. 2015

Clinical Microbiology and Infection

112

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show abstract

“…Alternatively, PET/CT may be proposed to improve spatial resolution. In this regard, preliminary data have demonstrated significant uptake of 18 F-FDG both in infected endocardial vegetations and at metastatic sites of infection (27)(28)(29)(30). However, 18 F-FDG uptake is observed in a variety of benign and malignant conditions such as inflammation or tumors (31), thus reducing its specificity.…”

Section: Discussionmentioning

confidence: 99%

Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Erba¹,

Conti²,

Lazzeri³

et al. 2012

J Nucl Med

213

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The clinical performance of the Duke Endocarditis Service criteria to establish the diagnosis of infectious endocarditis (IE) can be improved through functional imaging procedures such as radiolabeled leukocytes ( 99m Tc-hexamethylpropyleneamine oxime [HMPAO]-labeled white blood cells [WBC]). Methods: We assessed the value of 99m Tc-HMPAO-WBC scintigraphy including SPECT/CT acquisitions in a series of 131 consecutive patients with suspected IE. Patients with permanent cardiac devices were excluded. 99m Tc-HMPAO-WBC scintigraphy results were correlated with transthoracic or transesophageal echocardiography, blood cultures, and the Duke criteria. Results: Scintigraphy was true-positive in 46 of 51 and false-negative in 5 of 51 cases (90% sensitivity, 94% negative predictive value, and 100% specificity and positive predictive value). No false-positive results were found, even in patients with early IE evaluated within the first 2 mo from the surgical procedure. In 24 of 51 patients with IE, we also found extracardiac uptake, indicating septic embolism in 21 of 24. Despite the fact that septic embolism was found in 11 of 18 cases of Duke-definite IE, most of the added value from the 99m Tc-HMPAO-WBC scan for decision making was seen in patients in whom the Duke criteria yielded possible IE. The scan was particularly valuable in patients with negative or difficult-to-interpret echocardiographic findings because it correctly classified 11 of 88 of these patients as having IE. Furthermore, 3 patients were falsely positive at echocardiography but correctly negative at 99m Tc-HMPAO-WBC scintigraphy: these patients had marantic vegetations. Conclusion: Our results demonstrate the ability of 99m Tc-HMPAO-WBC scintigraphy to reduce the rate of misdiagnosed cases of IE when combined with standard diagnostic tests in several situations: when clinical suspicion is high but echocardiographic findings are inconclusive; when there is a need for differential diagnosis between septic and sterile vegetations detected at echocardiography; when echocardiographic, laboratory, and clinical data are contradictory; and when valve involvement (especially of a prosthetic valve) needs to be excluded during febrile episodes, sepsis, or postsurgical infections.

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“…En la actualidad numerosos estudios de investigación van dirigidos a asignar al PET un nuevo enfoque y una nueva utilidad diagnóstica en el campo de la patología infecciosa e inflamatoria, convirtiéndose en el nuevo paradigma en patologías como la endocarditis infecciosa, vasculitis de grandes vasos, enfermedad inflamatoria intestinal, infección de prótesis vasculares, fiebre de origen desconocido u osteomielitis crónica, entre otros [13][14][15][16][17][18] .…”

Section: Discussionunclassified

Estudio prospectivo para determinar el valor real de la captación de 18F-FDG mesentérica en pacientes oncológicos: ¿paniculitis mesentérica inflamatoria o tumoral?

Rincón

Regi

Hualde

et al. 2014

Revista Española de Medicina Nuclear e Imagen Molecular

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Possible role of F18-FDG-PET/CT in the diagnosis of endocarditis: preliminary evidence from a review of the literature

Cited by 36 publications

References 58 publications

The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis

The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis

Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Estudio prospectivo para determinar el valor real de la captación de 18F-FDG mesentérica en pacientes oncológicos: ¿paniculitis mesentérica inflamatoria o tumoral?

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Possible role of F18-FDG-PET/CT in the diagnosis of endocarditis: preliminary evidence from a review of the literature

Cited by 36 publications

References 58 publications

The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis

The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis

Added Value of 99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Estudio prospectivo para determinar el valor real de la captación de 18F-FDG mesentérica en pacientes oncológicos: ¿paniculitis mesentérica inflamatoria o tumoral?

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Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis