FDG PET/CT for the diagnosis and management of infective endocarditis: Expert consensus vs evidence-based practice

Chen, Wengen; Dilsizian, Vasken

doi:10.1007/s12350-018-1398-1

Cited by 19 publications

(10 citation statements)

References 20 publications

(15 reference statements)

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“…La PET-CT también puede ser útil en el seguimiento de estos pacientes en que basados en el valor estandarizado de captación máxima (SUVmáx), es posible decidir iniciar terapia antibiótica, aumentar la dosis o detener el tratamiento según otro estudio retrospectivo (4) . También ha demostrado utilidad en casos con sospecha de endocarditis aguda infecciosa (5) . En nuestro paciente, la PET-CT fue determinante en establecer el diagnóstico de infección sobre tubo protésico ante la incongruencia de hallazgos entre el ETE y la angio-TC de aorta.…”

Section: Discussionunclassified

Infección de tubo protésico en aorta ascendente. Rol de la tomografía por emisión de positrones en el diagnóstico y tratamiento. Reporte de caso

2019

Rev. Urug. Cardiol.

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Infección de tubo protésico en aorta ascendente. Rol de la tomografía por emisión de positrones en el diagnóstico y tratamiento. Reporte de caso Resumen La infección sobre injerto protésico a nivel de aorta ascendente se considera una rara complicación con una incidencia de 0,5%-6%, pero de alta mortalidad (88%), incluso con tratamiento quirúrgico. Los factores de riesgo vinculados a este tipo de infección son: diabetes mellitus, insuficiencia renal e insuficiencia cardíaca. El microorganismo más frecuentemente implicado es Staphylococcus aureus. La presentación clínica puede ser muy variada, desde cuadros oligosintomáticos hasta sepsis. En cuanto al diagnóstico, los métodos de imagen clásicos (ecocardiograma, angiotomografía aórtica) resultan de gran relevancia. En la última década, la tomografía por emisión de positrones ha adquirido un rol relevante en las situaciones que presentan dudas diagnósticas, como es el caso del paciente que analizaremos. Palabras clave: STAPHYLOCOCCUS AUREUS TOMOGRAFÍA POR EMISIÓN DE POSITRONES INFECCIÓN INJERTO PROTÉSICO AÓRTICOInfection of prosthetic aortic graft in ascending aorta and role of positron emission tomography in the diagnosis. Case report Summary Infection in a prosthetic graft in the ascending aorta is considered an infrequent complication with an incidence of 0.5%-6% but with high mortality (88%), even with surgical treatment. Related risk factors are diabetes mellitus, kidney failure and heart failure. The most frequent microorganism is Staphylococcus aureus. Clinical presentation can be very variable, from oligosymptomatic to sepsis. The classical imaging methods (ultrasonography, aortic angiotomography) are very relevant for diagnosis. In the last decade, positron emission tomography has acquired a relevant role in cases with diagnostic doubts, such as the patient to be analyzed.Infecção do tubo protético na aorta ascendente e papel do tomografia por emissão de pósitrons no diagnóstico. Relato de caso Resumo A infecção em prótese ao nível da aorta ascendente é considerada uma complicação rara, com incidência de 0,5%-6% mas com alta mortalidade (88%), mesmo com tratamento cirúrgico. Os fatores de risco ligados a esse tipo de infecção são: diabetes mellitus, insuficiência renal e insuficiência cardíaca. O microrganismo mais frequentemente implicado é o Staphylococcus aureus. A apresentação clínica pode ser muito variada, desde casos oligossintomáticos até sepse. Com relação ao diagnóstico, os métodos clássicos de imagem (ecocardiografia, angiotomografia aórtica) são altamente relevantes. Nas últimas décadas, a tomografia por emissão de pósitrons tem adquirido papel relevante nos casos que apresentam dúvidas diagnósticas como as do paciente, que será analisado.

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Section: Discussionunclassified

Infección de tubo protésico en aorta ascendente. Rol de la tomografía por emisión de positrones en el diagnóstico y tratamiento. Reporte de caso

2019

Rev. Urug. Cardiol.

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“…Because a definitive diagnosis of endocarditis has important treatment consequences such as prolonged intravenous use of antibiotics or even cardiac valve replacement, additional imaging such as FDG-PET/CT or alternatively white blood cell scintigraphy is often performed. Although FDG-PET/CT has a relatively low sensitivity of approximately 14% in patients with native valve endocarditis, it has a high sensitivity of 71-100% in patients with prosthetic valve endocarditis [30,31]. Nevertheless, FDG-PET/CT can still be valuable in native valve endocarditis for the detection of septic infection foci [30].…”

Section: Infective Endocarditismentioning

confidence: 99%

“…Although FDG-PET/CT has a relatively low sensitivity of approximately 14% in patients with native valve endocarditis, it has a high sensitivity of 71-100% in patients with prosthetic valve endocarditis [30,31]. Nevertheless, FDG-PET/CT can still be valuable in native valve endocarditis for the detection of septic infection foci [30]. In current European Society of Cardiology guidelines for the management of infective endocarditis, FDG-PET/CT is only included as a diagnostic technique in patients with suspected, but not definite, prosthetic valve endocarditis [32].…”

Section: Infective Endocarditismentioning

confidence: 99%

PET/CT Imaging for Personalized Management of Infectious Diseases

Pijl

Kwee

Slart

et al. 2021

JPM

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Positron emission tomography combined with computed tomography (PET/CT) is a nuclear imaging technique which is increasingly being used in infectious diseases. Because infection foci often consume more glucose than surrounding tissue, most infections can be diagnosed with PET/CT using 2-deoxy-2-[18F]fluoro-D-glucose (FDG), an analogue of glucose labeled with Fluorine-18. In this review, we discuss common infectious diseases in which FDG-PET/CT is currently applied including bloodstream infection of unknown origin, infective endocarditis, vascular graft infection, spondylodiscitis, and cyst infections. Next, we highlight the latest developments within the field of PET/CT, including total body PET/CT, use of novel PET radiotracers, and potential future applications of PET/CT that will likely lead to increased capabilities for patient-tailored treatment of infectious diseases.

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“…The use of 18 F-FDG PET/CT in the United States to image cardiac device infection is probably even lower, as such use has not been endorsed in the U.S. guidelines and is not currently reimbursed for infection or inflammation imaging. Although most of the studies using 18 F-FDG PET/CT for cardiac device infection are retrospective, current clinical practice and expert consensus support the judicious use of 18 F-FDG PET/CT in the workup of cardiovascular device infection (24,25). Table 1 compares anatomic (TEE and CT/CTA) and functional ( 18 F-FDG PET/CT, WBC scanning) imaging modalities for evaluation of cardiovascular device infection.…”

Section: Functional Imaging Toolsmentioning

confidence: 99%

Molecular Imaging of Cardiovascular Device Infection: Targeting the Bacteria or the Host–Pathogen Immune Response?

Chen¹,

Dilsizian²

2020

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to (1) understand the role of 18 F-FDG PET/CT for diagnosis of cardiovascular device infection, as a functional imaging tool for assessing the overall host-pathogen immune response in infection; (2) learn about the strengths and limitations of bacteria-targeting radiotracers for infection imaging, including those based on substances of bacterial maltodextrin transporters, bacterial thymidine kinase, antibiotics, antimicrobial peptides, antibacterial antibodies, bacteriophages, and bacterial DNA/RNA hybrid nucleotide oligomers; and (3) discuss the pros and cons of 18 F-FDG versus bacteria-targeting tracers. Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through March 2023. Rapid and accurate diagnosis of cardiovascular device infection remains a challenge in the clinic. Anatomic imaging tools such as echocardiography and cardiac CT or CT angiography are the firstline modalities for clinically suspected endocarditis given their ability to detect vegetation and perivalvular complications. Accumulating data suggest that functional imaging with 18 F-FDG PET/CT has unique merits over anatomic imaging and could potentially diagnose early cardiac device infection before morphologic damage ensues and identify infection sources or bacterial emboli in the rest of the body. Although an abnormal finding on 18 F-FDG PET/CT was added to the 2015 guidelines of the European Society of Cardiology as a major criterion for the diagnosis of device-related and prosthetic valve endocarditis, that addition has not been incorporated in the U.S. guidelines. Beyond these clinically available imaging tools, attempts have been made to develop bacteria-targeting tracers for specific infection imaging, which include tracers of bacterial maltodextrin transporter, bacterial thymidine kinase, antibiotics, antimicrobial peptides, bacterial antibodies, bacteriophages, and bacterial DNA/RNA hybrid nucleotide oligomers. Most of the tracers have been studied only in experimental animals, except for radiolabeled antibiotics, which have been examined in humans without success in clinical translation for infection imaging. In this article, we compare the roles of anatomic and functional imaging for cardiac device infection and discuss the pros and cons of 18 F-FDG and bacteria-targeting tracers. While anticipating continued investigations for bacteria-specific...

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FDG PET/CT for the diagnosis and management of infective endocarditis: Expert consensus vs evidence-based practice

Cited by 19 publications

References 20 publications

Infección de tubo protésico en aorta ascendente. Rol de la tomografía por emisión de positrones en el diagnóstico y tratamiento. Reporte de caso

Infección de tubo protésico en aorta ascendente. Rol de la tomografía por emisión de positrones en el diagnóstico y tratamiento. Reporte de caso

PET/CT Imaging for Personalized Management of Infectious Diseases

Molecular Imaging of Cardiovascular Device Infection: Targeting the Bacteria or the Host–Pathogen Immune Response?

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