Clinical impact of 18F-FDG-PET/CT in the extra cardiac work-up of patients with infective endocarditis

Abstract

18F-FDG-PET/CT detected lesions of clinical importance in one of seven IE patients and may be a substantial imaging technique for tracing peripheral infectious embolism due to IE. Thus, 18F-FDG-PET/CT may help to guide adequate therapy and thereby improve the prognosis of patients with IE.

Characterization of 18 F-Fluorodeoxyglucose Uptake Pattern in Noninfected Prosthetic Heart Valves

“…There is increasing evidence that FDG positron emission tomography (PET)/computed tomography (CT) may be useful in the management of infective endocarditis, both for detection of septic emboli [9][10][11][12][13] and for diagnosis of prosthetic valve infection. [14][15][16] A study showed that the sensitivity of the modified Duke criteria performed at admission was markedly increased when the presence of an abnormal FDG uptake was added as a major criterion.…”

Positron Emission Tomography/Computed Tomography Imaging in Device Infective Endocarditis

“…Radiolabeled leukocyte SPECT/CT imaging seems to be more specific for the detection of infective endocarditis and infectious foci than 18 F-FDG PET/CT. However, 18 F-FDG PET/CT is likely the preferred imaging technique, because SPECT/CT is less sensitive, more time consuming, and requires leukocyte labeling.…”

“…In patients with a high index of suspicion, a normal/inconclusive echocardiographic examination does not therefore rule out DIE, generating a significant rate of inconclusive diagnoses. For improving the accuracy of the Duke criteria, other imaging modalities such as multidetector computed tomography (CT), 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET), and single-photon emission computed tomography (SPECT) have recently gained importance. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] With the use of retrospective ECG-gated acquisitions and intravenous contrast to enhance vascular structures, currentgeneration CT scanners provide enough spatial detail to visualize the valvular structures at several different phases of the cardiac cycle without motion artifact.…”

“…Several reports have highlighted the potential added value of SPECT/ CT imaging of radiolabeled leukocytes and 18 F-FDG PET/CT in the diagnosis of DIE in patients with a negative or inconclusive routine workup with transthoracic echocardiography and TEE [9][10][11][12][13][14][15][16][17][18][19] (Table). Radiolabeled leukocyte SPECT/CT imaging seems to be more specific for the detection of infective endocarditis and infectious foci than 18 F-FDG PET/CT. However, 18 F-FDG PET/CT is likely the preferred imaging technique, because SPECT/CT is less sensitive, more time consuming, and requires leukocyte labeling.…”

“…[9][10][11][12][13][14] Interestingly, several reports showed that FDG-PET/CT could detect clinically unsuspected sites of extracardiac infection in up to 10% to 28% of cases. 18,19 In this issue of Circulation, Pizzi et al 17 evaluated the incremental value of 18 F-FDG-PET imaging in association with CT(A) over the modified Duke score at admission for the diagnosis of infective endocarditis in 75 patients with PV or cardiac devices (mostly cardiac implantable electronic devices). PET/ CTA acquisitions were classified as positive or negative.…”