Imaging of Endocarditis and Cardiac Device-Related Infections: An Update

Ferro, Paola; Boni, Roberto; Slart, Riemer H. J. A.; Erba, Paola Anna

doi:10.1053/j.semnuclmed.2023.01.001

Cited by 6 publications

(13 citation statements)

References 85 publications

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“…However, these criteria exhibit limited sensitivity and specificity [4][5][6], as reported in the most recent AHA/IDSA and ESC guidelines [3,7]. Despite the vast comprehension of IE clinical management, the morbimortality of this disease is still unacceptably high (20% at 30 days and 40-50% at subsequent follow-up) due to consequent complications [8].…”

Section: Introductionmentioning

confidence: 99%

“…The transthoracic (TTE) and transesophageal ultrasound (TEE) are usually employed as the gold standard in the diagnosis of IE. However, TTE especially fails to identify approximately 30% of the cases with prosthetic valve endocarditis (PVE) or infections in implantable electronic devices (CIED) [8]. In fact, when echocardiography fails to detect infective valve endocarditis, the Duke criteria show reduced diagnostic sensitivity [8].…”

Section: Introductionmentioning

confidence: 99%

“…However, TTE especially fails to identify approximately 30% of the cases with prosthetic valve endocarditis (PVE) or infections in implantable electronic devices (CIED) [8]. In fact, when echocardiography fails to detect infective valve endocarditis, the Duke criteria show reduced diagnostic sensitivity [8]. Moreover, the sensitivity of echocardiography is still limited depending on several factors related to the stage of the disease, the clinician's expertise, or even the prosthetic material-related imaging artifacts.…”

Section: Introductionmentioning

confidence: 99%

“…The major contribution of this imaging modality occurs in those cases where there is a high suspicion of IE and with a diagnosis of "Possible IE" or even "IE rejected" based on the other diagnostic criteria [6,10,[15][16][17]. The inclusion of the [ 18 F]FDG PET/CT imaging modality in the Duke criteria increased sensitivity from 57.1% to 83.5% [8].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, a homogeneous uptake pattern is related to reactive inflammatory activity and not to infection. On the contrary, a heterogeneous uptake pattern with multiple foci is related to an infectious process [3,8]. The radiomic-based approaches in diagnostic imaging are increasingly expanding in the clinical setting [30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

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Radiomic-Based Biomarkers for the Evaluation of Prosthetic Heart Valve Infective Endocarditis in Non-Attenuation Correction [18F]FDG PET/CT Images

Palomino-Fernández,

Gómez-Grande,

P. Seiffert

et al. 2024

Applied Sciences

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Although there have been crucial advancements in the diagnostic and treatment approaches, the mortality rate of infective endocarditis is still an ongoing challenge in clinical practice. [18F]FDG PET/CT imaging has recently proven its potential role in the early identification of prosthetic valve endocarditis (PVE). Due to radiomics’ rising applicability, recent studies exhibit promising outcomes in the clinical setting. The aim of the present study is the evaluation of potential radiomic-based biomarkers of non-attenuation-corrected (NAC) [18F]FDG PET images for the diagnosis of PVE. An adequate pre-processing and segmentation of the prosthetic ring metabolic activity were performed. A reproducibility analysis prior to the image-based biomarkers’ identification was conducted in terms of the intraclass correlation coefficient (ICC) derived from the variations in the radiomic extraction configurations (bin number and voxel size). After the reliability analysis, statistical analysis was performed by means of the Mann–Whitney U Test to study the differences between the PVE groups. Only p values < 0.05 after the Benjamini Hochberg correction procedure for multiple comparisons were considered statistically significant. Eight ML classification models for PVE classification based on radiomic features were evaluated. Overall, 45.2% and 95.7% of the radiomic features showed a consistency ICC above 0.82, demonstrating great reproducibility against variations in the bin number and interpolation thickness, respectively. Variations in interpolation thickness demonstrated great reproducibility in absolute agreement with 80.0% robust features, proving a non-dependency relationship with radiomic values. In the present study, the utility of potential radiomic-based biomarkers in the diagnosis of PVE in NAC [18F]FDG PET/CT images has been evaluated. Future studies will be required to validate the use of this technology as a valuable tool to support the current PVE diagnostic criteria.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiomic-Based Biomarkers for the Evaluation of Prosthetic Heart Valve Infective Endocarditis in Non-Attenuation Correction [18F]FDG PET/CT Images

Palomino-Fernández,

Gómez-Grande,

P. Seiffert

et al. 2024

Applied Sciences

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The Predictive Role of Metabolic Volume Segmentation Compared to Semiquantitative PET Parameters in Diagnosis of LVAD Infection using [18F]FDG Imaging

Novruzov,

Dabir,

Schmitt

et al. 2024

Mol Imaging Biol

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Purpose Left ventricular assisting device (LVAD) is a vital mechanical circulatory assist device for patients with end-stage heart disease, serving as either a bridge to transplantation or palliative destination therapy. Yet device infection represents a major lethal complication, warranting a multi-step, complex therapy approach including an urgent device exchange or heart transplantation. Still, timely diagnosis of site and extent of VAD-specific infection for a proper therapy planning poses challenges in regular clinical care. This single-center, retrospective study aimed to evaluate the impact of volumetric PET parameters with different thresholding compared to semiquantitative PET parameters for accurate diagnosis of VAD-specific infection. Procedures Seventeen patients (1 female, 16 males; mean age 57 ± 11 years) underwent [18F]FDG imaging for suspected VAD-specific infection between April 2013 and October 2023. Various metabolic and volumetric PET parameters with different thresholding were collected for specific LVAD components including driveline entry point, subcutaneous driveline, pump pocket, inner cannula and outflow tract. Microbiology and clinical follow-up were used as the final diagnosis standard. Results Nine of eleven patients with VAD-specific infection underwent urgent heart transplantation, and one had a surgical revision of LVAD. Two patients had non-VAD specific infections, and two had non-VAD related infections. Metabolic burden determination using a fixed absolute threshold provided the best outcome compared to relative thresholding or other metabolic SUV parameters. The total metabolic tumor volume (MTV) cutoff value was 9.3 cm3, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.43%, 82.5%, and 0.814 (95% CI 0.555–0.958), respectively. The total lesion glycolysis (TLG) was 30.6, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.4%, 82.5%, and 0.829 (95% CI 0.571–0.964), respectively. Conclusions Volumetric PET parameters with fixed absolute thresholding appear to be a valuable auxiliary tool in the evaluation of [18F]FDG imaging to enhance the diagnostic accuracy of VAD-specific infection.

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