ECG-Gated Cardiac FDG PET Acquisitions Significantly Improve Detectability of Infective Endocarditis

Boursier, Caroline; Duval, Xavier; Bourdon, A.; Imbert, Laëtitia; Mahida, Besma; Chevalier, E.; Claudin, Marine; Hoën, Bruno; Goehringer, François; Selton‐Suty, Christine; Roch, Véronique; Lamiral, Zohra; Humbert, Olivier; Rouzet, François; Marie, Pierre-Yves

doi:10.1016/j.jcmg.2020.06.036

Cited by 32 publications

(15 citation statements)

References 3 publications

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“…Also, ECG-gated acquisitions may possibly improve the detectability of abnormal uptake as recently shown in infective endocarditis. 13 Secondly, the study corroborates that semi-quantitative analysis does not allow to discriminate between infected and non-infected devices. The authors performed the analysis based on attenuation-corrected data only (SUVmax or SUV ratio), entailing a risk of overcorrection artifacts.…”

supporting

confidence: 65%

FDG PET/CT in CIEDs infection: Don’t wait any longer!

Piekarski

Mahida

Rouzet

et al. 2022

Journal of Nuclear Cardiology

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supporting

confidence: 65%

FDG PET/CT in CIEDs infection: Don’t wait any longer!

Piekarski

Mahida

Rouzet

et al. 2022

Journal of Nuclear Cardiology

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“…A proof of concept was shown for cardiac vitality PET [39]. Prospective studies are needed to evaluate whether these techniques have additive value over ) [36] static PET/CT imaging in the setting of IE, since evidence for this indication, though promising, remains scarce [40].…”

Section: Ecg Gatingmentioning

confidence: 99%

18F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization

et al. 2021

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Purpose of Review Additional imaging modalities, such as FDG-PET/CT, have been included into the workup for patients with suspected infective endocarditis, according to major international guidelines published in 2015. The purpose of this review is to give an overview of FDG-PET/CT indications and standardized approaches in the setting of suspected infective endocarditis. Recent Findings There are two main indications for performing FDG-PET/CT in patients with suspected infective endocarditis: (i) detecting intracardiac infections and (ii) detection of (clinically silent) disseminated infectious disease. The diagnostic performance of FDG-PET/CT for intracardiac lesions depends on the presence of native valves, prosthetic valves, or implanted cardiac devices, with a sensitivity that is poor for native valve endocarditis and cardiac device-related lead infections, but much better for prosthetic valve endocarditis and cardiac device-related pocket infections. Specificity is high for all these indications. The detection of disseminated disease may also help establish the diagnosis and/or impact patient management. Summary Based on current evidence, FDG-PET/CT should be considered for detection of disseminated disease in suspected endocarditis. Absence of intracardiac lesions on FDG-PET/CT cannot rule out native valve endocarditis, but positive findings strongly support the diagnosis. For prosthetic valve endocarditis, standard use of FDG-PET/CT is recommended because of its high sensitivity and specificity. For implanted cardiac devices, FDG-PET/CT is also recommended, but should be evaluated with careful attention to clinical context, because its sensitivity is high for pocket infections, but low for lead infections. In patients with prosthetic valves with or without additional aortic prosthesis, combination with CTA should be considered. Optimal timing of FDG-PET/CT is important, both during clinical workup and technically (i.e., post tracer injection). In addition, procedural standardization is key and encompasses patient preparation, scan acquisition, reconstruction, subsequent analysis, and clinical interpretation. The recommendations discussed here will hopefully contribute to improved standardization and enhanced performance of FDG-PET/CT in the clinical management of patients with suspected infective endocarditis.

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“… 8 We postulated that this particular PET recording technique may be well adapted to this setting, given the capacity of digital-PET to image low-count structures 9 and of ECG-triggered PET to prevent cardiac motion-related image blurring. 10 …”

Section: Introductionmentioning

confidence: 99%

Detection of acute myocarditis by ECG-triggered PET imaging of somatostatin receptors compared to cardiac magnetic resonance: preliminary results

Boursier

Chevalier

Varlot

et al. 2023

Journal of Nuclear Cardiology

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Somatostatin receptors are overexpressed by inflammatory cells but not by cardiac cells, under normal conditions. This study assesses the detection of acute myocarditis by the ECG-triggered digital-PET imaging of somatostatin receptors ( 68 Ga-DOTATOC-PET), as compared to Cardiac Magnetic Resonance (CMR) imaging, which is the reference diagnostic method in this setting. Methods Fourteen CMR-defined acute myocarditis patients had a first 15-minutes ECG-triggered 68 Ga-DOTATOC PET recording, 4.4 ± 3.0 days from peak troponin, and 10 had a second 4.3 ± 0.3 months later. Myocardial/blood SUVmax ratio was analyzed relative to the normal upper limit of 2.18, which had been previously determined from oncology 68 Ga-DOTATOC-PET recordings of patients with a similar age range as the myocarditis patients. Results An increased myocardial 68 Ga-DOTATOC uptake relative to blood activity was invariably observed during the acute phase. SUVmax ratio exceeded 2.18 in all patients during the acute phase but also in 3/10 patients at 4-months, at a time when there were no more signs of active inflammation on CMR. A residual myocardial 68 Ga-DOTATOC uptake was still observed on all gated-PET cine loops at 4-months. Conclusion These preliminary results suggest that 68 Ga-DOTATOC ECG-triggered digital-PET may be as sensitive as CMR at detecting myocarditis during the acute phase and more sensitive at later stages. Supplementary Information The online version contains supplementary material available at 10.1007/s12350-022-03090-6.

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ECG-Gated Cardiac FDG PET Acquisitions Significantly Improve Detectability of Infective Endocarditis

Cited by 32 publications

References 3 publications

FDG PET/CT in CIEDs infection: Don’t wait any longer!

FDG PET/CT in CIEDs infection: Don’t wait any longer!

18F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization

Detection of acute myocarditis by ECG-triggered PET imaging of somatostatin receptors compared to cardiac magnetic resonance: preliminary results

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