Role of radiolabelled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and inconclusive echocardiography

Hyafil, Fabien; Rouzet, François; Lepage, Laurent; Benali, Khadija; Raffoul, Richard; Duval, Xavier; Hvass, Ulrik; Iung, Bernard; Nataf, Patrick; Lebtahi, Rachida; Vahanian, Alec; Guludec, Dominique Le

doi:10.1093/ehjci/jet029

Cited by 94 publications

(65 citation statements)

References 19 publications

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“…Recently, 2 different imaging techniques have demonstrated their incremental value over echocardiography for the diagnosis of endocarditis: 18 F-FDG-PET (6,7) and radiolabeled leukocyte scintigraphy (8,9). Each of these techniques presents specific advantages and drawbacks for the detection of infection in patients with suspected PVE.…”

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confidence: 99%

Respective Performance of ¹⁸F-FDG PET and Radiolabeled Leukocyte Scintigraphy for the Diagnosis of Prosthetic Valve Endocarditis

et al. 2014

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Echocardiography plays a key role in the diagnosis of infective endocarditis (IE) but can be inconclusive in patients in whom prosthetic valve endocarditis (PVE) is suspected. The incremental diagnostic value of 18 F-FDG PET and radiolabeled leukocyte scintigraphy in IE patients has already been reported. The aim of this study was to compare the respective performance of 18 F-FDG PET and leukocyte scintigraphy for the diagnosis of PVE in 39 patients. Methods: 18 F-FDG PET and leukocyte scintigraphy were performed on 39 consecutive patients admitted because of clinically suspected PVE and inconclusive echocardiography results. The results of 18 F-FDG PET and leukocyte scintigraphy were analyzed separately and retrospectively by experienced physicians masked to the results of the other imaging technique and to patient outcome. The final Duke-Li IE classification was made after a 3-mo follow-up. Results: Of the 39 patients, 14 were classified as having definite IE, 4 as having possible IE, and 21 as not having IE. The average interval between 18 F-FDG PET and leukocyte scintigraphy was 7 ± 7 d. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 93%, 71%, 68%, 94%, and 80%, respectively, for 18 F-FDG PET and 64%, 100%, 100%, 81%, and 86%, respectively, for leukocyte scintigraphy. Discrepancies between the results of 18 F-FDG PET and leukocyte scintigraphy occurred in 12 patients (31%). In patients with definite IE, 5 had true-positive 18 F-FDG PET results but false-negative leukocyte scintigraphy results. Of these 5 patients, 3 had nonpyogenic microorganism IE (Coxiella or Candida). Of patients for whom endocarditis had been excluded, 6 had true-negative leukocyte scintigraphy results but false-positive 18 F-FDG PET results. These 6 patients had been imaged in the first 2 mo after the last cardiac surgery. The last patient with a discrepancy between 18 F-FDG PET and leukocyte scintigraphy was classified as having possible endocarditis and had positive 18 F-FDG PET results and negative leukocyte scintigraphy results. Conclusion: 18 F-FDG PET offers high sensitivity for the detection of active infection in patients with suspected PVE and inconclusive echocardiography results. Leukocyte scintigraphy offers a higher specificity, however, than 18 F-FDG PET for diagnosis of IE and should be considered in cases of inconclusive 18 F-FDG PET findings or in the first 2 mo after cardiac surgery.

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confidence: 99%

Respective Performance of ¹⁸F-FDG PET and Radiolabeled Leukocyte Scintigraphy for the Diagnosis of Prosthetic Valve Endocarditis

et al. 2014

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“…The method of labelled leukocytes is widely used for detection of the inflammatory foci of any localization, except pathology of the spleen and liver. According to data of various authors, this method demonstrates high rates of sensitivity and specificity in IE diagnosis (11). Moreover, there are data suggesting the presence of a positive correlation between the activity of the disease and the intensity of 99m Tclabelled leukocyte accumulation.…”

Section: Discussionmentioning

confidence: 93%

99mTc-HMPAO-Labeled Autologous Leukocyte SPECT/CT for Diagnosis of Bacterial Endocarditis of the Prosthetic Pulmonary Conduit: A Clinical Case

et al. 2016

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In this paper, we present a case of bacterial endocarditis of the prosthetic pulmonary conduit found in a 26-year-old man. An echocardiography study around the pulmonary valve showed the presence of a floating mass attached to the wall of the conduit. This formation was thought to be a floating calcific leaflet of the conduit or a developed vegetation of the conduit. Due to the uncertainty of the results, pulmonary multidetector row computed tomography (MDCT) angiography was performed. The MDCT examination showed the presence of a floating 4 × 8-mm sized mass in the pulmonary conduit. Taking into account the patient's complaints, medical history data, and clinical-instrumental examination, myocardial scintigraphy with 99m Tc-HMPAO-labelled autologous leukocytes combined with CT ( 99m Tc-HMPAO-SPECT/CT) was performed. Based on overlaying of the scintigraphic images and the MDCT aortography scans, anatomic localization of the pathologic accumulation was found in a projection of the pulmonary valve prosthesis. Surgical intervention, with cardiopulmonary bypass, was performed for replacement of the valve-containing conduit. Pathomorphologic study of the surgical material confirmed the hypothesis of bacterial endocarditis. Therefore, hybrid technologies such as 99m Tc-HMPAO-SPECT/CT contribute to the earlier and more precise diagnosis of infectious endocarditis, avoiding many errors associated with patient treatment and the development of complications.

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“…8 In a more selected population of 42 patients with a suspicion of PVE and inconclusive echocardiography, we confirmed the high specificity of this technique (100%) but found a lower sensitivity (57%) for the diagnosis of PVE compared to the former study. 9 Nevertheless, LS did influence the clinical management and classification of 29% of the patients included in this study.…”

Section: Fdg-pet-ctmentioning

confidence: 87%

Nuclear imaging for patients with a suspicion of infective endocarditis: Be part of the team!

Hyafil

Rouzet

Guludec

2017

Journal of Nuclear Cardiology

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Role of radiolabelled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and inconclusive echocardiography

Abstract: This study suggests that LS is useful for the identification of perivalvular infection in patients with a suspicion of PVE and inconclusive TEE.

Cited by 94 publications

References 19 publications

Respective Performance of ¹⁸F-FDG PET and Radiolabeled Leukocyte Scintigraphy for the Diagnosis of Prosthetic Valve Endocarditis

Respective Performance of ¹⁸F-FDG PET and Radiolabeled Leukocyte Scintigraphy for the Diagnosis of Prosthetic Valve Endocarditis

99mTc-HMPAO-Labeled Autologous Leukocyte SPECT/CT for Diagnosis of Bacterial Endocarditis of the Prosthetic Pulmonary Conduit: A Clinical Case

Nuclear imaging for patients with a suspicion of infective endocarditis: Be part of the team!

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Role of radiolabelled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and inconclusive echocardiography

Abstract: This study suggests that LS is useful for the identification of perivalvular infection in patients with a suspicion of PVE and inconclusive TEE.

Cited by 94 publications

References 19 publications

Respective Performance of 18F-FDG PET and Radiolabeled Leukocyte Scintigraphy for the Diagnosis of Prosthetic Valve Endocarditis

Respective Performance of 18F-FDG PET and Radiolabeled Leukocyte Scintigraphy for the Diagnosis of Prosthetic Valve Endocarditis

99mTc-HMPAO-Labeled Autologous Leukocyte SPECT/CT for Diagnosis of Bacterial Endocarditis of the Prosthetic Pulmonary Conduit: A Clinical Case

Nuclear imaging for patients with a suspicion of infective endocarditis: Be part of the team!

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Respective Performance of ¹⁸F-FDG PET and Radiolabeled Leukocyte Scintigraphy for the Diagnosis of Prosthetic Valve Endocarditis

Respective Performance of ¹⁸F-FDG PET and Radiolabeled Leukocyte Scintigraphy for the Diagnosis of Prosthetic Valve Endocarditis