Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM

Abstract

With this document, we provide a standard for PET/(diagnostic) CT imaging procedures in cardiovascular diseases that are inflammatory, infective, infiltrative, or associated with dysfunctional innervation (4Is). This standard should be applied in clinical practice and integrated in clinical (multicenter) trials for optimal procedural standardization. A major focus is put on procedures using [18F]FDG, but 4Is PET radiopharmaceuticals beyond [18F]FDG are also described in this document. Whilst these novel tracers are currently mainly applied in early clinical trials, some multicenter trials are underway and we foresee in the near future their use in clinical care and inclusion in the clinical guidelines. Finally, PET/MR applications in 4Is cardiovascular diseases are also briefly described. Diagnosis and management of 4Is-related cardiovascular diseases are generally complex and often require a multidisciplinary approach by a team of experts. The new standards described herein should be applied when using PET/CT and PET/MR, within a multimodality imaging framework both in clinical practice and in clinical trials for 4Is cardiovascular indications.

18F-FDG PET/CT improves diagnostic certainty in native and prosthetic valve Infective Endocarditis over the modified Duke Criteria

“…12 22 The increasing utilization of PET is reflected in the current study, where PET usage increased from 3.8% (January 2010-September 2015) to 14.6% (October 2015-December 2018) in line with the most recent ESC guidelines and the increasing body of evidence for PET in IE. 2,17 IE remains a diagnostic challenge, especially in the absence of positive major criterion of the mDC. In our cohort, all patients had ongoing clinical suspicion of IE following equivocal TOE in 68/69 cases (N = 1, patient refusal), and 26% with likely BCNIE (Table 1).…”

A Review on the Value of Imaging in Differentiating between Large Vessel Vasculitis and Atherosclerosis

“…Atherosclerosis typically has more focal or “patchy” FDG uptake. Diffuse uptake as a diagnostic criterion has also been used in previous research [ 12 ], and recommended in the analysis of LVV [ 13 , 29 ]. In addition to uptake pattern, FDG uptake intensity is thought to be higher in LVV than in atherosclerosis [ 30 ].…”

PET/CT Imaging for Personalized Management of Infectious Diseases

“…To increase the sensitivity of FDG-PET/CT for diagnosing endocarditis, adequate patient preparation is very important. Because myocardial tissue is highly glucose metabolic, patients should be kept on a low carbohydrate diet at least 24 h prior to FDG-PET/CT to suppress physiologic FDG uptake of the heart as this masks pathologic FDG uptake of the valves in case of endocarditis [35].…”