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

Hyafil, Fabien; Rouzet, François; Guludec, Dominique Le

doi:10.1007/s12350-015-0369-z

Cited by 18 publications

(8 citation statements)

References 15 publications

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“…As previously shown, 60% of blood cultures were negative [ 25 , 26 ]. Nuclear medicine may provide opportunities for personalized evaluation in order to choose the best therapeutic strategy [ 27 , 28 ]. Nonetheless, data on the diagnostic performance of 99mTc-HMPAO-SPECT/CT is very limited [ 8 , 11 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

99mTc-HMPAO-labeled leukocyte SPECT/CT and transthoracic echocardiography diagnostic value in infective endocarditis

Holcman

Szot

Rubiś

et al. 2018

Int J Cardiovasc Imaging

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Infective endocarditis (IE) is a life-threatening disease, establishing a diagnosis is often challenging. The aim of this prospective study was to evaluate and compare the diagnostic performance of the combined use of single photon emission tomography and computed tomography with technetium99m-hexamethylpropyleneamineoxime—labeled leukocytes (99mTc-HMPAO-SPECT/CT) with transthoracic echocardiography (TTE) in patients with suspected IE. We enrolled 40 consecutive patients (12 females, 28 males, mean age: 58.6 ± 18) with suspected IE in the years 2015–2016. All patients underwent clinical evaluation, TTE and 99mTc-HMPAO-SPECT/CT for the assessment of lesions typical for IE. Scans were evaluated for the presence and location of increased radioactivity foci, corresponding to the accumulation of radiolabeled leukocytes in inflammatory lesions. After 6 months, the patients were re-evaluated clinically and with TTE. Final IE diagnosis was established in 14 (35%) patients. Lesions typical for IE were shown in 28 (70%) TTEs and 16 (40%) 99mTc-HMPAO-SPECT/CTs. The latter tests were characterized by 90% accuracy, 93% sensitivity, 88% specificity, 96% negative predictive value (NPV), 81% positive predictive value (PPV). TTE demonstrated 60% accuracy, 93% sensitivity, 42% specificity, 92% NPV, and 46% PPV. 99mTc-HMPAO-SPECT/CT was characterized by a lower number of false-positive results compared to TTE (3 vs. 15). In patients with suspected IE, 99mTc-HMPAO-SPECT/CT yields a smaller number of false-positive results, significantly higher diagnostic accuracy, specificity and PPV than TTE. It helps to differentiate IE infectious and sterile echocardiographic lesions and reduces by 27% the number of misdiagnosed IE classified in the ‘possible IE’ category by modified Duke Criteria.

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Section: Discussionmentioning

confidence: 99%

99mTc-HMPAO-labeled leukocyte SPECT/CT and transthoracic echocardiography diagnostic value in infective endocarditis

Holcman

Szot

Rubiś

et al. 2018

Int J Cardiovasc Imaging

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“…SUV [7][8] on PET, but these diagnostic criteria will need to be validated in multi-centric prospective studies with a larger number of patients. In the similar way as with patients with a suspicion of PVE, 11 WBC SPECT might be useful for patients with inconclusive FDG-PET, either in patients with borderline FDG uptake values or in the pump region where the precise analysis and quantification of FDG uptake is more difficult.…”

Section: Diagnostic Criteria For Lvad Infection Using Fdg-pet Imagingmentioning

confidence: 99%

“…Before these data become available, the integration of FDG-PET in diagnostic and therapeutic strategies of patients with LVAD should be done carefully and, in a similar way to the management of patients with infective endocarditis, discussed in a multi-disciplinary team. 11 …”

Section: Which Role For Fdg-pet Imaging In the Management Of Lvad Infmentioning

confidence: 99%

FDG-PET for the detection of infection in left ventricle assist device: Is there light at the end of the tunnel?

Hyafil

Rouzet

Benali

2019

Journal of Nuclear Cardiology

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LEFT VENTRICULAR ASSIST DEVICESOver the past decade, the use of continuous-flow left ventricular assist devices (LVAD) has increased at a rapid pace. In the United States, approximately 2400 LVAD are implanted annually 1 and more than 16,000 patients have already received a continuous-flow LVAD. 2 These devices are a life-saving option for advanced heart failure patients who are either not eligible for a heart transplant or too ill to safely wait for a transplant on medical therapy alone. LVAD constitute the following components: (1) an inflow cannula surgically implanted into the left ventricular apex that extracts the blood from the left ventricle (LV) into the pump; (2) a pump enclosure with an impeller that circulates blood; (3) an outflow graft that pulses back the blood from the pump into the ascending aorta; and (4) a surgically tunneled driveline that connects the pump to an external controller that operates and monitors the pump function. The external controller is connected by two power cables to a battery powered source or a power module. Survival rates of patients are continuously improving after implantation of LVAD, but the number of adverse events remains quite high. Approximately 80% of patients will have experienced a major adverse event in the first 2 years after LVAD implantation. The most frequent complications of LVAD are bleeding, infection, and arrhythmia. 3 LVAD infection starts usually at the entry point of the percutaneous driveline and extends from there progressively to the LVAD pump. In case of driveline infection, a new driveline can be implanted in another site and connected to the pump. In case of pump infection, replacing the LVAD pump is challenging because of the development of tight adhesions between the system and the heart. The only remaining option is to try to control the progression of pump infection with long-term systemic antibiotherapy and consider urgent cardiac transplant in eligible patients. The precise evaluation of the extent of infection in the LVAD system is, therefore, key to guide the clinical management of these patients. NUCLEAR IMAGING FOR THE DETECTION OF LVAD INFECTIONWhite blood cell (WBC) SPECT and FDG-PET have both demonstrated their values for the detection of infection in cardiac implantable electronic devices and prosthesis 4 and might thus prove useful for the evaluation of LVAD. On the one hand, WBC SPECT was the first to be evaluated in this indication in a small study including eight patients with a suspicion of LVAD infection. 5 The accumulation of radiolabeled WBC was found highly specific for LVAD infection in this small cohort of patients and allowed for the identification of the extent of infection along the device. The logistics for WBC SPECT imaging are, however, quite demanding for Nuclear Medicine departments with the need to handle blood and radiolabeled cells in a hot lab under sterile conditions, and for patients who undergo two

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“…7 In this situation, additional criteria need to be taken into account such as the pattern of FDG uptake, the persistence of FDG signal on non-attenuation corrected images, the localization of the signal in relation to cardiac structures, and to morphological aspects observed on echocardiography or cardiac CTA. 10,11 In particular, the presence of focal or heterogeneous FDG signal extending outside the prosthetic contours is suggestive of infection. If the diagnostic of PVE remains uncertain, radiolabeled leukocyte scintigraphy can be helpful to discriminate between infective and inflammatory processes in valves, as this imaging technique is highly specific for infection.…”

Section: Integrating Clinical Biology and Imaging For The Diagnosticmentioning

confidence: 99%

Quantification of FDG uptake in patients with a suspicion of prosthetic valve endocarditis: Part of the problem or part of the solution?

Hyafil

Rouzet

Guludec

2018

Journal of Nuclear Cardiology

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

Cited by 18 publications

References 15 publications

99mTc-HMPAO-labeled leukocyte SPECT/CT and transthoracic echocardiography diagnostic value in infective endocarditis

99mTc-HMPAO-labeled leukocyte SPECT/CT and transthoracic echocardiography diagnostic value in infective endocarditis

FDG-PET for the detection of infection in left ventricle assist device: Is there light at the end of the tunnel?

Quantification of FDG uptake in patients with a suspicion of prosthetic valve endocarditis: Part of the problem or part of the solution?

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