What Can We Learn About Valvular Heart Disease From PET/CT?

Jenkins, William; Chin, Calvin; Rudd, James H.F.; Newby, David E.; Dweck, Marc R

doi:10.2217/fca.13.47

Cited by 10 publications

(2 citation statements)

References 82 publications

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“…The current method of diagnosis uses modified Duke criteria (MDC), which are divided into “major criteria” (typical blood culture and positive echocardiography) and “minor criteria” (predisposition, fever, vascular phenomena, immunologic phenomena, suggestive echocardiogram, and suggestive microbiologic findings). However, it creates a problem for patients with equivocal clinical symptoms in the absence of conventional echocardiographic features (particularly when prosthetic heart valves are present), making the diagnosis difficult [ 23 ]. Imaging modalities such as transesophageal echocardiogram (TEE), CT, and magnetic resonance imaging (MRI) have been studied.…”

Section: State Of Pet Imaging In Infectious Diseasesmentioning

confidence: 99%

Is Imaging Bacteria with PET a Realistic Option or an Illusion?

et al. 2023

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The application of [18F]-fluorodeoxyglucose ([18F]FDG) as a radiotracer to detect sites of inflammation (either due to bacterial infection or primary inflammation) has led to exploring the role of PET in visualizing bacteria directly at sites of infection. However, the results from such efforts are controversial and inconclusive so far. We aimed to assess the limitations of PET as an effective modality in the diagnosis of bacterial infections. Inflammation due to bacterial infections can be visualized by using [18F]FDG-PET. However, the non-specificity of [18F]FDG makes it undesirable to visualize bacteria as the underlying cause of inflammation. Hence, more specific radiotracers that possibly bind to or accumulate in bacteria-specific receptors or enzymes are being explored. Several radiotracers, including 2-deoxy-2-[18F]fluorosorbitol ([18F]FDS), 6-[18F]-fluoromaltose, [11C]para-aminobenzoic acid ([11C]PABA), radiolabeled trimethoprim (11C-TMP) and its analog fluoropropyl-trimethoprim (18F-FPTMP), other radiolabeled sugars, and antimicrobial drugs have been used to image microorganisms. Unfortunately, no progress has been made in translating the results to routine human use; feasibility and other factors have constrained their success in clinical settings. In the current article, we discuss the limitations of direct bacterial visualization with PET tracers, but emphasize the important role of [18F]FDG-PET as the only option for detecting evidence of infection.

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Section: State Of Pet Imaging In Infectious Diseasesmentioning

confidence: 99%

Is Imaging Bacteria with PET a Realistic Option or an Illusion?

et al. 2023

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“…Recently, the novel application of hybrid PET/CT imaging has been used to study patients with aortic stenosis, providing unique and important insights into its pathophysiology. 29 18 F-Fluoride is a PET tracer that is believed to act as a marker of newly developing calcium in the vasculature. It preferentially binds to these regions of newly developing microcalcification because of the high surface area of nanocrystaline hydroxyapatite crystals compared with established macroscopic calcium deposits, where much of the calcium is internalized and unavailable for binding.…”

Section: Assessing Activity Of Aortic Valve Calcificationmentioning

confidence: 99%

Risk Stratification in Patients With Aortic Stenosis Using Novel Imaging Approaches

Chin

Pawade

Newby

et al. 2015

Circ: Cardiovascular Imaging

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Downloaded from Chin et al Novel Imaging in Aortic Stenosisaortic stenosis. 19 Unfortunately, this 4-point score remains semiquantitative and limited by poor interobserver agreement.Electrocardiography-gated noncontrast computed tomography (CT) is able to provide more detailed information with respect to the density, volume, and mass of macroscopic calcium deposits within the aortic valve. CT calcium scoring of the valve is similar to the approach used in the coronary arteries and most commonly expressed as Agatston units (AU). Indeed, aortic valve CT calcium scoring demonstrates high intra, interobserver, and scan-rescan reproducibility (a limitation with the echocardiographic calcium score) 20,21 and correlates well with the calcium weight of excised valves 20 and other echocardiographic parameters of aortic stenosis severity. 17,[20][21][22] Interestingly, patients with more severe disease at baseline experienced more rapid progression of aortic valve calcification on CT ( Figure 1B), and multiple studies have also demonstrated a strong relationship between baseline calcium scores and the rate of subsequent disease progression. 16,17,23 CT calcium scoring of the aortic valve holds potential as an alternative assessment of aortic stenosis severity. Indeed, CT assessment holds several potential advantages over and above echocardiography, as it is independent from flow, geometric assumptions, and the presence of other cardiovascular conditions, such as hypertension and mitral regurgitation. Until recently, we lacked appropriate thresholds to differentiate patients with severe and nonsevere disease, thereby limiting the clinical utility of this technique.These thresholds were recently proposed in a multicenter study involving >600 patients with at least moderate aortic stenosis and preserved ejection fraction who had undergone both CT and echocardiography. Using sex-specific thresholds (men, ≥2065 AU or ≥476 AU/cm 2 when indexed to aortic annular area and women, ≥1274 AU or ≥292 AU/cm 2 ), aortic valve CT calcium score defined severe aortic stenosis with high accuracy (sensitivity, ≥86% and specificity, ≥79%). 24,25 Moreover, the prognostic effect of these calcium score thresholds was subsequently F-Fluoride ( 18 F-NaF; a marker of novel calcification) activity increased markedly with severity of aortic stenosis (AS). Conversely,18 F-fluorodeoxyglucose ( 18 F-FDG; a marker of inflammation) activity had a more modest association with AS severity. This supports the notion that calcification rather than inflammation predominates in the valve, particularly in the later stages of the disease. Furthermore, aortic valve CT calcium score is of particular clinical relevance in patients with discordant small aortic valve area and low mean pressure gradient where the true severity of the disease remains uncertain. This commonly affects up to a third of patients with moderate or severe disease and can be because of either low flow states (as a consequence of a depressed left ventricular ejection fraction or a small ventric...

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Imaging Modalities in the Diagnosis and Treatment of Acquired Heart Valve Disease

Clarke

2021

Valvular Heart Disease

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What Can We Learn About Valvular Heart Disease From PET/CT?

Cited by 10 publications

References 82 publications

Is Imaging Bacteria with PET a Realistic Option or an Illusion?

Is Imaging Bacteria with PET a Realistic Option or an Illusion?

Risk Stratification in Patients With Aortic Stenosis Using Novel Imaging Approaches

Imaging Modalities in the Diagnosis and Treatment of Acquired Heart Valve Disease

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