1
|
Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and Radiolabeled Leukocyte SPECT/CT Imaging for the Evaluation of Cardiovascular Infection in the Multimodality Context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations From ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. JACC Cardiovasc Imaging 2024; 17:669-701. [PMID: 38466252 DOI: 10.1016/j.jcmg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multisocietal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multifocal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
Collapse
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Heart Rhythm 2024; 21:e1-e29. [PMID: 38466251 DOI: 10.1016/j.hrthm.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
Collapse
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. J Nucl Cardiol 2024; 34:101786. [PMID: 38472038 DOI: 10.1016/j.nuclcard.2023.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
Collapse
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Clin Infect Dis 2024:ciae046. [PMID: 38466039 DOI: 10.1093/cid/ciae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
Collapse
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Arslan M, Haider A, Khurshid M, Abu Bakar SSU, Jani R, Masood F, Tahir T, Mitchell K, Panchagnula S, Mandair S. From Pixels to Pathology: Employing Computer Vision to Decode Chest Diseases in Medical Images. Cureus 2023; 15:e45587. [PMID: 37868395 PMCID: PMC10587792 DOI: 10.7759/cureus.45587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Radiology has been a pioneer in the healthcare industry's digital transformation, incorporating digital imaging systems like picture archiving and communication system (PACS) and teleradiology over the past thirty years. This shift has reshaped radiology services, positioning the field at a crucial junction for potential evolution into an integrated diagnostic service through artificial intelligence and machine learning. These technologies offer advanced tools for radiology's transformation. The radiology community has advanced computer-aided diagnosis (CAD) tools using machine learning techniques, notably deep learning convolutional neural networks (CNNs), for medical image pattern recognition. However, the integration of CAD tools into clinical practice has been hindered by challenges in workflow integration, unclear business models, and limited clinical benefits, despite development dating back to the 1990s. This comprehensive review focuses on detecting chest-related diseases through techniques like chest X-rays (CXRs), magnetic resonance imaging (MRI), nuclear medicine, and computed tomography (CT) scans. It examines the utilization of computer-aided programs by researchers for disease detection, addressing key areas: the role of computer-aided programs in disease detection advancement, recent developments in MRI, CXR, radioactive tracers, and CT scans for chest disease identification, research gaps for more effective development, and the incorporation of machine learning programs into diagnostic tools.
Collapse
Affiliation(s)
- Muhammad Arslan
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, National Health Service (NHS) Lothian, Edinburgh, GBR
| | - Ali Haider
- Department of Allied Health Sciences, The University of Lahore, Gujrat Campus, Gujrat, PAK
| | - Mohsin Khurshid
- Department of Microbiology, Government College University Faisalabad, Faisalabad, PAK
| | | | - Rutva Jani
- Department of Internal Medicine, C. U. Shah Medical College and Hospital, Gujarat, IND
| | - Fatima Masood
- Department of Internal Medicine, Gulf Medical University, Ajman, ARE
| | - Tuba Tahir
- Department of Business Administration, Iqra University, Karachi, PAK
| | - Kyle Mitchell
- Department of Internal Medicine, University of Science, Arts and Technology, Olveston, MSR
| | - Smruthi Panchagnula
- Department of Internal Medicine, Ganni Subbalakshmi Lakshmi (GSL) Medical College, Hyderabad, IND
| | - Satpreet Mandair
- Department of Internal Medicine, Medical University of the Americas, Charlestown, KNA
| |
Collapse
|
6
|
Ferro P, Boni R, Bartoli F, Lazzeri F, Slart RHJA, Erba PA. Radionuclide Imaging of Infective Endocarditis. Cardiol Clin 2023; 41:233-249. [PMID: 37003680 DOI: 10.1016/j.ccl.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Infective endocarditis (IE) is associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient management. Due to difficulties in the diagnosis, a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data is used. Imaging, including echocardiography, molecular imaging techniques, and coronary CT angiography (CTA) is central to detect infections involving heart valves and implanted cardiovascular devices, also allowing for early detection of septic emboli and metastatic. This article describes the main clinical application of white blood cell SPECT/CT and [18F]FDG-PET/CT and CTA in IE and infections associated with cardiovascular implantable electronic devices.
Collapse
Affiliation(s)
- Paola Ferro
- Nuclear Medicine Department ASST Ospedale Papa Giovanni XXIII Bergamo (Italy), Piazza OMS 1, Bergamo 24127, Italy
| | - Roberto Boni
- Nuclear Medicine Department ASST Ospedale Papa Giovanni XXIII Bergamo (Italy), Piazza OMS 1, Bergamo 24127, Italy
| | - Francesco Bartoli
- Department of Translational Research and Advanced Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Via Roma 57, Pisa I-56126, Italy
| | - Francesca Lazzeri
- Department of Translational Research and Advanced Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Via Roma 57, Pisa I-56126, Italy
| | - Riemer H J A Slart
- Medical Imaging Center, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Paola A Erba
- Department of Medicine and Surgery, University of Milan Bicocca and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII Bergamo (Italy), Piazza OMS 1, Bergamo 24127, Italy.
| |
Collapse
|
7
|
Infection of Vascular Prostheses: A Comprehensive Review. PROSTHESIS 2023. [DOI: 10.3390/prosthesis5010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Vascular graft or endograft infection (VGEI) is a complex disease that complicates vascular-surgery and endovascular-surgery procedures and determines high morbidity and mortality. This review article provides the most updated general evidence on the pathogenesis, prevention, diagnosis, and treatment of VGEI. Several microorganisms are involved in VGEI development, but the most frequent one, responsible for over 75% of infections, is Staphylococcus aureus. Specific clinical, surgical, radiologic, and laboratory criteria are pivotal for the diagnosis of VGEI. Surgery and antimicrobial therapy are cornerstones in treatment for most patients with VGEI. For patients unfit for surgery, alternative treatment is available to improve the clinical course of VGEI.
Collapse
|
8
|
Arnon-Sheleg E, Keidar Z. Vascular Graft Infection Imaging. Semin Nucl Med 2023; 53:70-77. [PMID: 36104271 DOI: 10.1053/j.semnuclmed.2022.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 01/28/2023]
Abstract
Vascular graft infection is a rare, life threatening complication of vascular repair with synthetic or native material. The pathogenesis, causative microorganisms and clinical manifestations vary according to graft's location and time duration since surgery. The diagnosis of graft infection is challenging since there is no single "gold standard" test and diagnosis is based on clinical and radiological criteria. Early and accurate diagnosis are essential for patient management and prevention of further complications. The first-choice imaging modality is computed tomography angiography (CTA) that can demonstrate typical signs of graft infection but has limited sensitivity and specificity, especially in early and low-grade infections. Nuclear medicine imaging methods, including labeled white blood cell scintigraphy and FDG PET/CT demonstrate improved diagnostic accuracy and play a pivotal role in the diagnosis of vascular graft infection. The different radiologic and the nuclear medicine imaging techniques, their advantages and limitations, and the recent guidelines detailing their use are reviewed.
Collapse
Affiliation(s)
- Elite Arnon-Sheleg
- Departments of Nuclear Medicine and Diagnostic Radiology, Galilee Medical Center, Nahariya, and the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam HealthCare Campus, and the Faculty of Medicine, Technion - the Israeli Institute of Technology, Haifa, Israel
| |
Collapse
|
9
|
Rahimi M, Adlouni M, Ahmed AI, Alnabelsi T, Chinnadurai P, Al-Mallah MH. Diagnostic accuracy of FDG PET for the identification of Vascular Graft Infection. Ann Vasc Surg 2022; 87:422-429. [PMID: 35760267 DOI: 10.1016/j.avsg.2022.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fluorodeoxyglucose (FDG) positron emission tomography (FDG PET/CT) can be used to identify and localize infection in patients with vascular graft infections (VGI). We aimed to evaluate the diagnostic accuracy of 18F-FDG PET/CT by defining thresholds for standardized uptake value (SUV) and tissue-to-background ratio (TBR) that would accurately identify the presence of vascular graft infection. METHODS Patients with suspected VGI were prospectively recruited and underwent 18F-FDG PET/CT scans. Diagnosis was based on clinical, laboratory and radiologic findings, and blinded to the results of the PET/CT scan. Receiver operator characteristics (ROC) curve analysis was done to determine optimal thresholds for SUV and TBR. RESULTS Our final cohort consisted of 28 patients with suspected VGI (mean±SD age 67±10 years, 61% men), of which 15 patients (54%) had definitive VGI. The cohort included 61% prosthetics grafts and 39% stent-grafts. The type of graft included in this study were biologic (4%), Dacron (64%) and Polytetrafluoroethylene (32%). The location of the implanted grafts were aortic (54%) and peripheral arterial reconstruction (46%). The location of the peripheral graft was 77% in lower extremity and 23% in the upper extremity (arterio-venous grafts for dialysis access). Using ROC analysis, SUV max of 4.5, SUV mean of 3.7, and a TBR of 1.6 gave the best balance between sensitivity and specificity (93%/92%, 100%/92% and 93%/92% respectively). All thresholds had an area under the curve ≥0.93 and correct reclassification rate ≥93%. CONCLUSION Our data suggests that FDG PET/CT can be used to reliably and accurately diagnose VGI. The dual anatomic-physiologic information from FDG PET/CT can complement clinical diagnosis particularly in uncertain cases.
Collapse
Affiliation(s)
- Maham Rahimi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX
| | | | | | | | | | | |
Collapse
|
10
|
Erba PA, Bartoli F, Sollini M, Raffaella B, Zanca R, Enrica E, Lazzeri E. Alternative Nuclear Imaging Tools for Infection Imaging. Curr Cardiol Rep 2022; 24:879-891. [PMID: 35696046 PMCID: PMC9288362 DOI: 10.1007/s11886-022-01708-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
Purpose of Review Cardiovascular infections are serious disease associated with high morbidity and mortality. Their diagnosis is challenging, requiring a proper management for a prompt recognition of the clinical manifestations, and a multidisciplinary approach involving cardiologists, cardiothoracic surgeons, infectious diseases specialist, imagers, and microbiologists. Imaging plays a central role in the diagnostic workout, including molecular imaging techniques. In this setting, two different strategies might be used to image infections: the first is based on the use of agents targeting the microorganism responsible for the infection. Alternatively, we can target the components of the pathophysiological changes of the inflammatory process and/or the host response to the infectious pathogen can be considered. Understanding the strength and limitations of each strategy is crucial to select the most appropriate imaging tool. Recent Findings Currently, multislice computed tomography (MSCT) and nuclear imaging (18F-fluorodeoxyglucose positron emission tomography/computed tomography, and leucocyte scintigraphy) are part of the diagnostic strategies. The main role of nuclear medicine imaging (PET/CT and SPECT/CT) is the confirmation of valve/CIED involvement and/or associated perivalvular infection and the detection of distant septic embolism. Proper patients’ preparation, imaging acquisition, and reconstruction as well as imaging reading are crucial to maximize the diagnostic information. Summary In this manuscript, we described the use of molecular imaging techniques, in particular WBC imaging, in patients with infective endocarditis, cardiovascular implantable electronic device infections, and infections of composite aortic graft, underlying the strength and limitations of such approached as compared to the other imaging modalities.
Collapse
Affiliation(s)
- Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy.
- Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Francesco Bartoli
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Berchiolli Raffaella
- Vascular Surgery Unit, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberta Zanca
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Esposito Enrica
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy
| | - Elena Lazzeri
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy
| |
Collapse
|
11
|
Lauri C, Signore A, Glaudemans AWJM, Treglia G, Gheysens O, Slart RHJA, Iezzi R, Prakken NHJ, Debus ES, Honig S, Lejay A, Chakfé N. Evidence-based guideline of the European Association of Nuclear Medicine (EANM) on imaging infection in vascular grafts. Eur J Nucl Med Mol Imaging 2022; 49:3430-3451. [PMID: 35376992 PMCID: PMC9308572 DOI: 10.1007/s00259-022-05769-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/16/2022] [Indexed: 12/14/2022]
Abstract
Purpose Consensus on optimal imaging procedure for vascular graft/endograft infection (VGEI) is still lacking and the choice of a diagnostic test is often based on the experience of single centres. This document provides evidence-based recommendations aiming at defining which imaging modality may be preferred in different clinical settings and post-surgical time window. Methods This working group includes 6 nuclear medicine physicians appointed by the European Association of Nuclear Medicine, 4 vascular surgeons, and 2 radiologists. Vascular surgeons formulated 5 clinical questions that were converted into 10 statements and addressed through a systematic analysis of available literature by using PICOs (Population/problem–Intervention/Indicator–Comparator–Outcome) strategy. Each consensus statement was scored for level of evidence and for recommendation grade, according to the Oxford Centre for Evidence-based Medicine criteria. Results Sixty-six articles, published from January 2000 up to December 2021, were analysed and used for evidence-based recommendations. Conclusion Computed tomography angiography (CTA) is the first-line imaging modality in suspected VGEI but nuclear medicine modalities are often needed to confirm or exclude the infection. Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) has very high negative predictive value but it should be performed preferably at least 4 months after surgery to avoid false positive results. Radiolabelled white blood cell (WBC) scintigraphy, given its high diagnostic accuracy, can be performed at any time after surgery. Preamble The European Association of Nuclear Medicine (EANM) is a professional no-profit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. The EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The EANM recognizes that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized. These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the EANM suggests caution against the use of the current consensus document in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgement regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in the light of all the circumstances presented. Thus, there is no implication that an approach differing from the consensus document, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the consensus document when, in the reasonable judgement of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the consensus document. The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to this consensus document will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient, to deliver effective and safe medical care. The sole purpose of this consensus document is to assist practitioners in achieving this objective. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05769-x.
Collapse
|
12
|
Nuclear medicine practice in the field of infection and inflammation imaging: a pragmatical survey. Eur J Nucl Med Mol Imaging 2022; 49:2113-2119. [PMID: 35175376 DOI: 10.1007/s00259-022-05725-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
13
|
Lauri C, Prosperi D, Taurino M, Signore A. Gamma-Camera Imaging of Vascular Graft Infections. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
14
|
Gamma camera imaging of infectious endocarditis. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
15
|
Mikail N, Hyafil F. Nuclear Imaging in Infective Endocarditis. Pharmaceuticals (Basel) 2021; 15:ph15010014. [PMID: 35056069 PMCID: PMC8777992 DOI: 10.3390/ph15010014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease with stable prevalence despite prophylactic, diagnostic, and therapeutic advances. In parallel to the growing number of cardiac devices implanted, the number of patients developing IE on prosthetic valves and cardiac implanted electronic device (CIED) is increasing at a rapid pace. The diagnosis of IE is particularly challenging, and currently relies on the Duke-Li modified classification, which include clinical, microbiological, and imaging criteria. While echocardiography remains the first line imaging technique, especially in native valve endocarditis, the incremental value of two nuclear imaging techniques, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) and white blood cells single photon emission tomography with computed tomography (WBC-SPECT), has emerged for the management of prosthetic valve and CIED IE. In this review, we will summarize the procedures for image acquisition, discuss the role of 18F-FDG-PET/CT and WBC-SPECT imaging in different clinical situations of IE, and review the respective diagnostic performance of these nuclear imaging techniques and their integration into the diagnostic algorithm for patients with a suspicion of IE.
Collapse
Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, Beaujon University Hospital, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110 Clichy, France;
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8006 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, CH-8952 Schlieren, Switzerland
| | - Fabien Hyafil
- Department of Nuclear Medicine, Georges-Pompidou European Hospital, DMU IMAGINA, Assistance Publique-Hôpitaux de Paris, University of Paris, 20 Rue Leblanc, 75015 Paris, France
- Correspondence: ; Tel.: +33-01-56-09-56-24
| |
Collapse
|
16
|
Sollini M, Bartoli F, Boni R, Zanca R, Colli A, Levantino M, Menichetti F, Ferrari M, Berchiolli R, Lazzeri E, Erba PA. Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure. Front Cardiovasc Med 2021; 8:745556. [PMID: 34926606 PMCID: PMC8671629 DOI: 10.3389/fcvm.2021.745556] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose: This study aimed to assess the diagnostic performances of multimodal imaging [i.e., white blood cell single-photon emission computed tomography/CT (99mTc-HMPAO-WBC SPECT/CT) and 18-fluoride-fluorodeoxyglucose positron emission tomography/CT ([18F]FDG PET/CT)] in patients with suspected infection after the Bentall procedure, proposing new specific diagnostic criteria for the diagnosis. Methods: Between January 2009 and December 2019, we selected within a cardiovascular infections registry, 76 surgically treated patients (27 women and 49 men, median 66 years, and range 29–83 years). All the patients underwent molecular imaging for a suspected infection after the replacement of the aortic valve and ascending aorta according to the Bentall procedure. We analyzed 98 scans including 49 99mTc-WBC and 49 [18F]FDG PET/CT. A total of 22 patients with very early/early suspected infection (<3 months after surgery) were imaged with both the techniques. Positive imaging was classified according to the anatomical site of increased uptake: to the aortic valve (AV), to both the AV and AV tube graft (AVTG) or to the TG, to surrounding tissue, and/or to extracardiac sites (embolic events or other sites of concomitant infection). Standard clinical workup included in all the patients having echocardiography/CT, blood culture, and the Duke criteria. Pretest probability and positive/negative likelihood ratio were calculated. Sensitivity and specificity of 99mTc labeled hexamethylpropylene amine oxime-WBC SPECT/CT (99mTc-HMPAO-WBC SPECT/CT) and [18F]FDG PET/CT imaging were calculated by using microbiology (n = 35) or clinical follow-up (n = 41) as final diagnosis. 99mTc-HMPAO-WBC scintigraphy and [18F]FDG PET/CT findings were compared with 95% CIs by using the McNemar test to those of echocardiography/CT, blood culture, and the Duke criteria. Results: Sensitivity, specificity, and accuracy of 99mTc-HMPAO-WBC were 86, 92, and 88%, respectively, with a slightly higher sensitivity for tube graft infection (TGI) as compared to isolated AV and combined AVTG. Overall, sensitivity, specificity, and accuracy of [18F]FDG PET/CT were 97, 73, and 90%, respectively. In 22 patients with suspected very early and early postsurgical infections, the two imaging modalities were concordant in 17 cases [10 true positive (TP) and 7 true negative (TN)]. [18F]FDG PET/CT presented a higher sensitivity than 99mTc-HMPAO-WBC scan. 99mTc-HMPAO-WBC scan correctly classified as negative three false-positive (FP) PET/CT findings. Conclusion: Our findings supported the use of 99mTc-HMPAO-WBC SPECT/CT and [18F]FDG PET/CT in patients with suspicion infection after the Bentall procedure early in the course of the disease onset to confirm the diagnosis and provide a comprehensive assessment of disease burden through the proposed criteria.
Collapse
Affiliation(s)
- Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesco Bartoli
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Roberto Boni
- Unità Operativa Complessa Medicina Nucleare, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberta Zanca
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Colli
- Division of Cardiovascular Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Maurizio Levantino
- Division of Cardiovascular Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Mauro Ferrari
- Vascular Surgery, Department of Translational Research and Advanced Technology in Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Raffaella Berchiolli
- Vascular Surgery, Department of Translational Research and Advanced Technology in Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Elena Lazzeri
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Paola A Erba
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.,Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Centre, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
17
|
Mahmoodi Z, Salarzaei M, Sheikh M. Prosthetic vascular graft infection: A systematic review and meta-analysis on diagnostic accuracy of 18FDG PET/CT. Gen Thorac Cardiovasc Surg 2021; 70:219-229. [PMID: 34309812 DOI: 10.1007/s11748-021-01682-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/10/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION There is a high risk of mortality and morbidity associated with Vascular Graft Infections (VGI) which requires early diagnosis. The aim of the present systematic review and meta-analysis was to evaluate the diagnostic accuracy, sensitivity and specificity of 18FDG PET/CT in diagnosing VGI. METHODS A systematic review was conducted according to the PRISMA guidelines through a search in Embase, PubMed, and Cochrane databases. We evaluated five parameters including specificity, sensitivity, negative and positive predictive values (NPV and PPV), and accuracy. We used STATA/MP 15.0 (StataCorp, College Station, TX) for all of our analyses. RESULTS Overall 10 studies including 320 patients undergone 18FDG PET/CT were included. The sensitivity, specificity, positive and negative likelihood ratios along with their 95% CI were 0.92 (95% CI 0.88-0.95), 0.76 (95% CI 0.76-0.70), 3.49 (95% CI 3.49-2.32) and 0.14 (95% CI 0.09-0.23), respectively. The diagnostic odds ratio (DOR) for diagnosis of VGI was 37.12 (95% CI 14.84-92.82). The mean cut-off value of the maximum standardized uptake value (SUVmax) for diagnosis of VGI was 5.39 while the overall mean SUVmax among patients with VGI was 8.47. CONCLUSION According to our results, 18FDG PET/CT is a useful diagnostic method in detecting active VGI with high diagnostic accuracy. Because of its ability to evaluate morphology and main texture using SUVmax, the 18FDG PET/CT provides an objective assessment of aspects and extent of disease activity, which results in preventing unnecessary surgery, proper treatment planning, and evaluating the effectiveness of treatment.
Collapse
Affiliation(s)
- Zohre Mahmoodi
- Department of Cardiology, Zabol University of Medical Sciences, Zabol, Iran
| | - Morteza Salarzaei
- General Physician, Zabol University of Medical Sciences, Zabol, Iran
| | - Mahboobeh Sheikh
- Department of Cardiology, Zabol University of Medical Sciences, Zabol, Iran.
| |
Collapse
|
18
|
(The Role of PET/CT in Angiology). COR ET VASA 2020. [DOI: 10.33678/cor.2020.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
de la Rubia-Marcos M, García-Alonso P, Mena-Melgar C, Tagliatori-Nogueira B, Herrero-Muñoz A, Sandoval-Moreno C, Paniagua-Correa C, Castillejos-Rodríguez L, Ortega-Valle A, Balsa-Bretón M. 99mTC-white blood cell scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
20
|
Abstract
Purpose of Review The main goal of the article is to familiarize the reader with commonly and uncommonly used nuclear medicine procedures that can significantly contribute to improved patient care. The article presents examples of specific modality utilization in the chest including assessment of lung ventilation and perfusion, imaging options for broad range of infectious and inflammatory processes, and selected aspects of oncologic imaging. In addition, rapidly developing new techniques utilizing molecular imaging are discussed. Recent Findings The article describes nuclear medicine imaging modalities including gamma camera, SPECT, PET, and hybrid imaging (SPECT/CT, PET/CT, and PET/MR) in the context of established and emerging clinical applications. Areas of potential future development in nuclear medicine are discussed with emphasis on molecular imaging and implementation of new targeted tracers used in diagnostics and therapeutics (theranostics). Summary Nuclear medicine and molecular imaging provide many unique and novel options for the diagnosis and treatment of pulmonary diseases. This article reviews current applications for nuclear medicine and molecular imaging and selected future applications for radiopharmaceuticals and targeted molecular imaging techniques.
Collapse
|
21
|
Parker MFL, Flavell RR, Luu JM, Rosenberg OS, Ohliger MA, Wilson DM. Small Molecule Sensors Targeting the Bacterial Cell Wall. ACS Infect Dis 2020; 6:1587-1598. [PMID: 32433879 DOI: 10.1021/acsinfecdis.9b00515] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This review highlights recent efforts to detect bacteria using engineered small molecules that are processed and incorporated similarly to their natural counterparts. There are both scientific and clinical justifications for these endeavors. The use of detectable, cell-wall targeted chemical probes has elucidated microbial behavior, with several fluorescent labeling methods in widespread laboratory use. Furthermore, many existing efforts including ours, focus on developing new imaging tools to study infection in clinical practice. The bacterial cell wall, a remarkably rich and complex structure, is an outstanding target for bacteria-specific detection. Several cell wall components are found in bacteria but not mammals, especially peptidoglycan, lipopolysaccharide, and teichoic acids. As this review highlights, the development of laboratory tools for fluorescence microscopy has vastly outstripped related positron emission tomography (PET) or single photon emission computed tomography (SPECT) radiotracer development. However, there is great synergy between these chemical strategies, which both employ mimicry of endogenous substrates to incorporate detectable structures. As the field of bacteria-specific imaging grows, it will be important to understand the mechanisms involved in microbial incorporation of radionuclides. Additionally, we will highlight the clinical challenges motivating this imaging effort.
Collapse
Affiliation(s)
- Matthew F. L. Parker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Justin M. Luu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Oren S. Rosenberg
- Department of Medicine, University of California, San Francisco, San Francisco, California 94158, United States
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, California 94110, United States
| | - David M. Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| |
Collapse
|
22
|
99mTC-white blood cell scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. Rev Esp Med Nucl Imagen Mol 2020; 39:347-352. [PMID: 32616455 DOI: 10.1016/j.remn.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/20/2022]
Abstract
AIM Vascular graft infection is a rare complication with a high morbidity and mortality. Early diagnosis is essential to establish an adequate treatment. We assess the accuracy of 99mTc-WBC scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. MATERIALS AND METHODS We retrospectively analyzed thirty 99mTc-WBC scintigraphies with SPECT/CT performed in thirty patients with suspicion of vascular prosthesis infection. Studies were considered positive for graft infection if the intensity of activity involving the graft was greater than the liver or bone marrow activity (spine and pelvis). RESULTS Final diagnosis of infection was established in 10 patients, based on Fitzgerald criteria. Scintigraphy was positive in 11 patients. No false negatives were obtained. The values of sensitivity and specificity were 100% and 95%, respectively, with a PPV of 91% and a NPV of 100%. Twenty five patients had a CT performed prior to scintigraphy, in 9 cases the result was positive and in the remaining 16 was negative. CT sensitivity and specificity obtained in our study were 62.5% and 76% respectively, with a PPV of 55.6% and a NPV of 81.3%. Diagnosis of infection led to prosthesis exeresis in 8 cases (all of them had a positive microbiological study of the extracted material), while the remaining 2 patients were treated with antibiotic therapy alone due to high surgical risk. CONCLUSION Our results suggest a high accuracy for 99mTc-WBC scintigraphy with SPECT/CT in the assessment of clinically suspected arterial graft infection.
Collapse
|
23
|
Lauri C, Iezzi R, Rossi M, Tinelli G, Sica S, Signore A, Posa A, Tanzilli A, Panzera C, Taurino M, Erba PA, Tshomba Y. Imaging Modalities for the Diagnosis of Vascular Graft Infections: A Consensus Paper amongst Different Specialists. J Clin Med 2020; 9:jcm9051510. [PMID: 32429584 PMCID: PMC7290746 DOI: 10.3390/jcm9051510] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022] Open
Abstract
Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients.
Collapse
Affiliation(s)
- Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands;
- Correspondence: ; Tel.: +39-06-3377-6191
| | - Roberto Iezzi
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.I.); (A.P.); (A.T.)
| | - Michele Rossi
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.T.); (S.S.); (Y.T.)
| | - Simona Sica
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.T.); (S.S.); (Y.T.)
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands;
| | - Alessandro Posa
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.I.); (A.P.); (A.T.)
| | - Alessandro Tanzilli
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.I.); (A.P.); (A.T.)
| | - Chiara Panzera
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy; (C.P.); (M.T.)
| | - Maurizio Taurino
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy; (C.P.); (M.T.)
| | - Paola Anna Erba
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands;
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56123 Pisa, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.T.); (S.S.); (Y.T.)
| |
Collapse
|
24
|
Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 266] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
25
|
Bowles H, Ambrosioni J, Mestres G, Hernández-Meneses M, Sánchez N, Llopis J, Yugueros X, Almela M, Moreno A, Riambau V, Fuster D, Miró JM. Diagnostic yield of 18F-FDG PET/CT in suspected diagnosis of vascular graft infection: A prospective cohort study. J Nucl Cardiol 2020; 27:294-302. [PMID: 29907934 DOI: 10.1007/s12350-018-1337-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prosthetic vascular graft infection (PVGI) is a severe complication associated with high morbidity and mortality. Clinical diagnosis is complex, requiring image testing such as CT angiography or leukocyte scintigraphy, which has considerable limitations. The aim of this study was to know the diagnostic yield of PET/CT with 18F-Fluorodeoxyglucose (18F-FDG) in patients with suspected PVGI. METHODS We performed a prospective cohort study including 49 patients with suspected PVGI, median age of 62 ± 14 years. Three uptake patterns were defined following published recommendations: (i) focal, (ii) patched (PVGI criteria), and (iii) diffuse (no PVGI criterion). RESULTS Sensitivity, specificity, and positive and negative predictive values for 18F-FDG-PET/CT were 88%, 79%, 67%, and 93%, respectively. 18F-FDG-PET/CT identified 14/16 cases of PVGI showing a focal (n = 10) or patched pattern (n = 4), being true negative in 26/33 cases with either a diffuse pattern (n = 16) or without uptake (n = 10). Five of the seven false-positive cases (71%) showed a patched pattern and all coincided with the application of adhesives for PVG placement. CONCLUSIONS 18F-FDG-PET/CT is a useful technique for the diagnosis of PVGI. A patched pattern on PET/CT in patients in whom adhesives were applied for prosthetic vascular graft placement does not indicate infection.
Collapse
Affiliation(s)
- Hans Bowles
- Nuclear Medicine Department, Hospital Clínic i Provincial de Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Gaspar Mestres
- Cardiovascular Surgery Department, Hospital Clinic, Barcelona, Spain
| | | | - Nuria Sánchez
- Nuclear Medicine Department, Hospital Clínic i Provincial de Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | - Jaime Llopis
- Statistics Department, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Xavier Yugueros
- Cardiovascular Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Manel Almela
- Clinical Microbiology Department, Hospital Clínic, Barcelona, Spain
| | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Vicenç Riambau
- Cardiovascular Surgery Department, Hospital Clinic, Barcelona, Spain
| | - David Fuster
- Nuclear Medicine Department, Hospital Clínic i Provincial de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| |
Collapse
|
26
|
Sarrazin JF, Trottier M, Tessier M. How useful is 18F-FDG PET/CT in patients with suspected vascular graft infection? J Nucl Cardiol 2020; 27:303-304. [PMID: 30046981 DOI: 10.1007/s12350-018-1377-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Jean-François Sarrazin
- Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725, Chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada.
| | | | | |
Collapse
|
27
|
Molecular Imaging of Inflammation and Infection. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Medricka M, Janeckova J, Koranda P, Buriankova E, Bachleda P. 18F-FDG PET/CT and 99mTc-HMPAO-WBC SPECT/CT effectively contribute to early diagnosis of infection of arteriovenous graft for hemodialysis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 163:341-348. [PMID: 31219107 DOI: 10.5507/bp.2019.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE An arteriovenous graft (AVG) is indicated in hemodialysis patients with failed arteriovenous access. Early treatment of AVG infection is important because an advanced prosthetic infection leads to the removal of the prosthesis. The aim of this study was to evaluate the benefits of 18F-FDG PET/CT and 99mTc-HMPAO-WBC SPECT/CT in early detection of AVG infections. SUBJECTS AND METHODS Fifty-one AVGs were evaluated. 18F-FDG PET/CT and 99mTc-HMPAO-WBC SPECT/CT studies were performed at intervals of 10, 20-30, and 40-50 weeks after AVG insertion. Agreement between the imaging methods and reference parameters (i.e. clinical presentation, C-reactive protein and microbiological findings on the hemodialysis cannula extracted after hemodialysis from AVG) was evaluated. RESULTS The study results showed that focal accumulation of the radiopharmaceuticals can be considered a sign of AVG infection. At 10 weeks after AVG implantation, the focal 18F-FDG findings showed the best agreement with the reference parameters (agreement coefficients AC1 - clinical status: 0.693, CRP: 0.605, cannula microbiology: 0.518, respectively). At 20 to 30 weeks after AVG implantation, the diagnostic value of focal 99mTc-HMPAO-WBC accumulation increased (AC1 coefficients: 0.658, 0.658, 0.408) and was similar to that of focal 18F-FDG uptake (AC1s: 0.656, 0.570, 0.409). Between 40 and 50 weeks since AVG implantation, the diagnostic significance of focal 99mTc-HMPAO-WBC accumulation (AC1 coefficients: 0.771, 0.811, 0.611) slightly exceeded the diagnostic value of focal 18F-FDG accumulation (AC1 coefficients: 0.524, 0.456, 0.569). CONCLUSION 18F-FDG PET/CT and 99mTc-HMPAO-WBC SPECT/CT can both serve as important tools contributing to early diagnosis of AVG infection.
Collapse
Affiliation(s)
- Monika Medricka
- Department of Vascular and Transplantation Surgery, University Hospital Olomouc, Czech Republic
| | - Jana Janeckova
- Department of Vascular and Transplantation Surgery, University Hospital Olomouc, Czech Republic
| | - Pavel Koranda
- Department of Nuclear Medicine, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - Eva Buriankova
- Department of Nuclear Medicine, University Hospital Olomouc and Palacky University, Olomouc, Czech Republic
| | - Petr Bachleda
- Department of Vascular and Transplantation Surgery, University Hospital Olomouc, Czech Republic
| |
Collapse
|
29
|
Graulus E, Schepens M. Perspective: options in managing aortic graft infections. Indian J Thorac Cardiovasc Surg 2019; 35:186-191. [PMID: 33061085 PMCID: PMC7525362 DOI: 10.1007/s12055-018-0664-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 02/21/2018] [Accepted: 02/28/2018] [Indexed: 11/29/2022] Open
Abstract
Thoracic aortic graft infections are infrequent, but are associated with high mortality and morbidity risk. To prevent these life-threatening infections, one must be aware of pathogenesis. When it occurs, a multidisciplinary (surgeon, radiologist, microbiologist, nuclear specialist, infectiologist, anesthesiologist, intensive care specialist) cascade must be initiated. A fast and accurate diagnosis using diagnostic criteria is vital. The appropriate treatment consists of a combination of antibiotics and surgery. Whether or not the vascular prosthesis is preserved depends on a case-by-case basis (tailor-made). Several graft preservation strategies have proven their effectiveness.
Collapse
Affiliation(s)
- Eric Graulus
- Department of Cardiovascular Surgery, General Hospital Saint John, Ruddershove 10, B-8000 Bruges, Belgium
| | - Marc Schepens
- Department of Cardiovascular Surgery, General Hospital Saint John, Ruddershove 10, B-8000 Bruges, Belgium
| |
Collapse
|
30
|
Puges M, Bérard X, Ruiz JB, Debordeaux F, Desclaux A, Stecken L, Pereyre S, Hocquelet A, Bordenave L, Pinaquy JB, Cazanave C. Retrospective Study Comparing WBC scan and 18F-FDG PET/CT in Patients with Suspected Prosthetic Vascular Graft Infection. Eur J Vasc Endovasc Surg 2019; 57:876-884. [PMID: 31130421 DOI: 10.1016/j.ejvs.2018.12.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/21/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Prosthetic vascular graft infections (PVGIs) are associated with high mortality rates. To improve treatment outcome, an early and definite diagnosis is critical, and current diagnostic criteria are often insufficient. The accuracy of 2-deoxy-2-[fluorine-18]-fluoro-d-glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) and white blood cell (WBC) scan for the diagnosis of PVGI were compared. METHODS A retrospective single centre study was conducted on patients undergoing WBC scan and 18F-FDG PET/CT for a suspected PVGI between April 2013 and June 2016 at the Bordeaux University Hospital, France. The diagnostic value of both imaging tests was assessed for all grafts, using receiver operating characteristic (ROC) curve analysis. Images were independently interpreted by two nuclear medicine physicians blinded to the patients' clinical and other imaging data. RESULTS Thirty-nine patients were included, of whom 15 had PVGI. Antibiotic treatment was started before nuclear imaging for 16 patients, including nine patients with a PVGI. The 96 grafts of these patients were analysed, and 19 were infected. The diagnostic value of the WBC scan was significantly higher than 18F-FDG PET/CT (ROC AUC = 0.902, 95% CI 0.824-0.980, and 0.759, CI 95% (0.659-0.858), respectively, p = .0071). Interobserver agreement was good for 18F-FDG PET/CT and excellent for WBC scan (kappa value of 0.76, 95% CI 0.62-0.9, and 0.97, 95% CI 0.92-1, respectively). Only one patient had a false negative 18F-FDG PET/CT result under antibiotic therapy. CONCLUSION The WBC scan has a better diagnostic value than 18F-FDG PET/CT for PVGI diagnosis.
Collapse
Affiliation(s)
- Mathilde Puges
- Infectious and Tropical Diseases Department, University Hospital of Bordeaux, Bordeaux, France; University of Bordeaux, Bordeaux, France.
| | - Xavier Bérard
- University of Bordeaux, Bordeaux, France; Vascular Surgery Department, University Hospital of Bordeaux, Bordeaux, France; CIC 1401, University Hospital of Bordeaux, Bordeaux, France
| | - Jean-Baptiste Ruiz
- Nuclear Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | - Frederic Debordeaux
- Nuclear Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | - Arnaud Desclaux
- Infectious and Tropical Diseases Department, University Hospital of Bordeaux, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Laurent Stecken
- Anaesthetics Department, University Hospital of Bordeaux, Bordeaux, France
| | - Sabine Pereyre
- University of Bordeaux, Bordeaux, France; Bacteriology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Arnaud Hocquelet
- Nuclear Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | - Laurence Bordenave
- University of Bordeaux, Bordeaux, France; CIC 1401, University Hospital of Bordeaux, Bordeaux, France; Nuclear Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Charles Cazanave
- Infectious and Tropical Diseases Department, University Hospital of Bordeaux, Bordeaux, France; University of Bordeaux, Bordeaux, France
| |
Collapse
|
31
|
Two decades of SPECT/CT - the coming of age of a technology: An updated review of literature evidence. Eur J Nucl Med Mol Imaging 2019; 46:1990-2012. [PMID: 31273437 PMCID: PMC6667427 DOI: 10.1007/s00259-019-04404-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was introduced as a hybrid SPECT/CT imaging modality two decades ago. The main advantage of SPECT/CT is the increased specificity achieved through a more precise localization and characterization of functional findings. The improved diagnostic accuracy is also associated with greater diagnostic confidence and better inter-specialty communication. METHODS This review presents a critical assessment of the relevant literature published so far on the role of SPECT/CT in a variety of clinical conditions. It also includes an update on the established evidence demonstrating both the advantages and limitations of this modality. CONCLUSIONS For the majority of applications, SPECT/CT should be a routine imaging technique, fully integrated into the clinical decision-making process, including oncology, endocrinology, orthopaedics, paediatrics, and cardiology. Large-scale prospective studies are lacking, however, on the use of SPECT/CT in certain clinical domains such as neurology and lung disorders. The review also presents data on the complementary role of SPECT/CT with other imaging modalities and a comparative analysis, where available.
Collapse
|
32
|
Affiliation(s)
- Jayer Chung
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS 390, Houston, TX 77030, USA.
| |
Collapse
|
33
|
Reinders Folmer EI, Von Meijenfeldt GCI, Van der Laan MJ, Glaudemans AWJM, Slart RHJA, Saleem BR, Zeebregts CJ. Diagnostic Imaging in Vascular Graft Infection: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2018; 56:719-729. [PMID: 30122333 DOI: 10.1016/j.ejvs.2018.07.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/09/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vascular graft infection (VGI), a serious complication in vascular surgery, has a high morbidity and mortality rate. The diagnosis is complicated by non-specific symptoms and challenged by the variable accuracy of different imaging techniques. The objective of this study was to determine the diagnostic value of various imaging techniques to diagnose VGI. METHODS A systematic review was conducted according to the PRISMA guidelines. Data sources included PubMed/Medline, Embase, and Cochrane from January 1997 until October 2017. Observational cohort studies were included. A meta-analysis was conducted on several imaging modalities: computed tomography with or without angiography (CT(A)), 18F-fluoro-d-deoxyglucose positron emission tomography with or without low dose or contrast enhanced CT (FDG-PET(/CT)), and white blood cell scintigraphy with or without single photon emission computed tomography combined with low dose CT (WBC (SPECT/CT)). RESULTS Of 4259 papers, 14 articles were included, containing eight prospective and six retrospective articles. CTA (I2 7.4%), FDG-PET (I2 36.5%), and FDG-PET/CT (I2 36.6%) showed negligible to moderate heterogeneity, while WBC scintigraphy ± SPECT/CT (I2 78.6%) showed considerable heterogeneity. Pooled sensitivity for CTA was 0.67 (95% CI 0.57-0.75), in contrast to FDG-PET of 0.94 (95% CI 0.88-0.98), FDG-PET/CT of 0.95 (95% CI 0.87-0.99), WBC scintigraphy of 0.90 (95% CI 0.85-0.94), and WBC scintigraphy with SPECT/CT of 0.99 (95% CI 0.92-1.00). The pooled specificities were for CTA 0.63 (95% CI 0.48-0.76), FDG-PET 0.70 (95% CI 0.59-0.79), FDG-PET/CT 0.80 (95% CI 0.69-0.89), WBC scintigraphy 0.88 (95% CI 0.81-1.94), and WBC scintigraphy SPECT/CT 0.82 (95% CI 0.57-0.96). Pre- and post-test results showed that WBC SPECT/CT favours FDG-PET/CT, with a positive post-test probability of 96% versus 83%. CONCLUSION This meta-analysis suggests the diagnostic performance of WBC scintigraphy combined with SPECT/CT is the greatest in diagnosing VGI. However, it is a time consuming technique and not always available. Therefore FDG-PET/CT may be favourable as the initial imaging technique. The use of solitary CTA in diagnosing VGI seems to be obsolete.
Collapse
Affiliation(s)
- Eline I Reinders Folmer
- Department of Surgery (Division of Vascular Surgery), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerdine C I Von Meijenfeldt
- Department of Surgery (Division of Vascular Surgery), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten J Van der Laan
- Department of Surgery (Division of Vascular Surgery), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Ben R Saleem
- Department of Surgery (Division of Vascular Surgery), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
34
|
Mitra A, Pencharz D, Davis M, Wagner T. Determining the Diagnostic Value of 18F-Fluorodeoxyglucose Positron Emission/Computed Tomography in Detecting Prosthetic Aortic Graft Infection. Ann Vasc Surg 2018; 53:78-85. [PMID: 30012456 DOI: 10.1016/j.avsg.2018.04.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/03/2018] [Accepted: 04/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND To determine the diagnostic value of 18F-fluorodeoxyglucose positron emission/computed tomography (FDG PET/CT) in detecting prosthetic aortic graft infection (AGI). METHODS Twenty-one patients with prosthetic grafts for abdominal aortic aneurysms underwent FDG PET/CT scans for suspected graft infection over a 15-month period. Images were evaluated for tracer pattern and grade of FDG uptake in addition to measuring the maximal standardized uptake value (SUVmax). Two independent nuclear medicine physicians retrospectively evaluated all imaging. The images from a control group of patients with aortic grafts who underwent FDG PET/CT scans for onco-hematological indications were evaluated to establish radiological characteristics of asymptomatic grafts. Secondary parameters that are associated with graft infection such as components of the peripheral blood count were collected. Graft infection status was determined using microbiological outcomes following graft explantation or radiological drainage of perigraft collections and correlated with results of the FDG PET/CT scans to determine infective status. RESULTS In the control group, the pattern of FDG uptake was homogenous and diffuse. The mean SUVmax was 3.5 (±1.3). Thirteen out of 21 grafts were confirmed as infected. Tracer uptake in infected grafts displayed an intense and focal pattern, with a median grade of uptake of 4 vs. 2 on a validated 4 point grading scale. The area under the receiver operating curve for FDG PET/CT in detecting infection was 0.85 (±0.15) P = 0.01. Sensitivity was 92%, specificity 63%, and positive and negative predictive values of 80% and 83%, respectively. The SUVmax was significantly higher in infected than noninfected grafts, (10.3 ± 4.2 vs. 5.4 ± 3.4) P = 0.02. According to the receiver operating characteristic analysis, SUVmax greater than 6.3 represented the optimal cutoff between infective and noninfective outcome. Of the secondary parameters collected, grade of uptake and SUVmax were the only significant predictors of infection (odds ratio 2.5, 1.5 respectively) P = 0.05. White cell count, erythrocyte sedimentation rate, and C-reactive protein demonstrated nonsignificant odds ratios of 1.4, 0.9, and 1.0, respectively. CONCLUSIONS FDG PET/CT is a valuable diagnostic test for identifying AGI. Infected grafts display significantly greater FDG uptake in a distinctive intense focal perigraft pattern and distribution. SUVmax greater than 6.3 is a good cutoff to determine infective status.
Collapse
|
35
|
Sollini M, Berchiolli R, Delgado Bolton RC, Rossi A, Kirienko M, Boni R, Lazzeri E, Slart R, Erba PA. The "3M" Approach to Cardiovascular Infections: Multimodality, Multitracers, and Multidisciplinary. Semin Nucl Med 2018; 48:199-224. [PMID: 29626939 DOI: 10.1053/j.semnuclmed.2017.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiovascular infections are associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient management, as early treatment improves the prognosis. The diagnosis cannot be made on the basis of a single symptom, sign, or diagnostic test. Rather, the diagnosis requires a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data. The application of multimodality imaging, including molecular imaging techniques, has improved the sensitivity to detect infections involving heart valves and vessels and implanted cardiovascular devices while also allowing for early detection of septic emboli and metastatic infections before these become clinically apparent. In this review, we describe data supporting the use of a Multimodality, Multitracer, and Multidisciplinary approach (the 3M approach) to cardiovascular infections. In particular, the role of white blood cell SPECT/CT and [18F]FDG PET/CT in most prevalent and clinically relevant cardiovascular infections will be discussed. In addition, the needs of advanced hybrid equipment, dedicated imaging acquisition protocols, specific expertise for image reading, and interpretation in this field are discussed, emphasizing the need for a specific reference framework within a Cardiovascular Multidisciplinary Team Approach to select the best test or combination of tests for each specific clinical situation.
Collapse
Affiliation(s)
- Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Raffaella Berchiolli
- Vascular Surgery Unit Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logronño, La Rioja, Spain
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Margarita Kirienko
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Roberto Boni
- Nuclear Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Elena Lazzeri
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Riemer Slart
- University Medical Center Groningen, Medical Imaging Center, University of Groningen, Groningen, The Netherlands; Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; University Medical Center Groningen, Medical Imaging Center, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
36
|
Sollini M, Raffaella B, Bandera F, Lazzeri E, Erba PA. Detection of Device Infection Using Nuclear Cardiology Imaging. ACTA ACUST UNITED AC 2018. [DOI: 10.17996/anc.18-00078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Berchiolli Raffaella
- Department of Translational Research and Advanced Technologies in Medicine, University of Pisa
- Vascular Surgery Unit, Azienda Ospedaliero-Universitaria Pisana
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milan
- Department of Cardiology University, IRCCS Policlinico San Donato
| | - Elena Lazzeri
- Department of Translational Research and Advanced Technologies in Medicine, University of Pisa
- Regional Center of Nuclear Medicine, Azienda Ospedaliero-Universitaria
| | - Paola Anna Erba
- Department of Translational Research and Advanced Technologies in Medicine, University of Pisa
- Regional Center of Nuclear Medicine, Azienda Ospedaliero-Universitaria
| |
Collapse
|
37
|
Marín-Oyaga V, Gutierrez-Villamil C, García-Concha D, Arevalo-Leal S. Usefulness of scintigraphy with labeled leucocytes and SPECT/CT in vascular graft infection. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
38
|
Marín-Oyaga V, Gutierrez-Villamil C, García-Concha D, Arevalo-Leal S. Usefulness of scintigraphy with labelled leucocytes and SPECT/CT in vascular graft infection. Rev Esp Med Nucl Imagen Mol 2017; 36:388-391. [PMID: 28619419 DOI: 10.1016/j.remn.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
Vascular graft infections are a rare complication in this type of procedure. However, when they do occur, they usually have high morbidity, and even a high mortality. Proper identification and location is crucial for the appropriate and early management, whether medical or surgical, thus knowledge of the right tools is paramount. Nuclear medicine studies play an important role in this regard, either by using labelled white blood cells scintigraphy or 18F-FDG. The choice, among other factors, will depend on the experience with both techniques by the different groups, their knowledge of them, as well as their availability. Two cases are presented in which 99mTc-HMPAO-white blood cells SPECT/CT scintigraphy was very useful in the diagnosis and location of the suspected infectious compromise, which led to the subsequent appropriate and guided management. Both cases were confirmed clinically and microbiologically.
Collapse
Affiliation(s)
- V Marín-Oyaga
- Servicio de Medicina Nuclear, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia; Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
| | - C Gutierrez-Villamil
- Servicio de Medicina Nuclear, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia; Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - D García-Concha
- Facultad de Medicina, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - S Arevalo-Leal
- Servicio de Medicina Nuclear, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia; Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
39
|
Inoue T, Imura M, Kaneda T, Saga T. Long-Term Survival After Coverage With Prevertebral Fascia for Abdominal Aortic Stump Closure. Vasc Endovascular Surg 2017; 51:43-46. [DOI: 10.1177/1538574416687735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abdominal aortic graft-enteric fistula is an uncommon but grave complication. Acceptable early results of its management have been reported in recent years, but aortic stump disruption remains a dreaded problem in the remote period. This report describes a case of a 71-year-old male with graft-enteric fistula following after a distant abdominal aortic aneurysm repair. The patient underwent 1-stage operation with extra-anatomic bypass preceding the complete removal of the infected aortic graft and intestinal repair. For coverage of the aortic stump closure, the prevertebral fascia was harvested as a flap and was successfully used to buttress the closure. Additionally, omental wrap was secured around the stump and around the area after complete graft removal. Postoperative intravenous antibiotic with meropenem was administered for 8 weeks, followed by suppression with ongoing oral antibiotic with trimethoprim–sulfamethoxazole for 6 months. Although sigmoidectomy and the left ureteral reconstruction were required, the patient is doing well without recurrent infection and without stump disruption after 8 years of follow-up.
Collapse
Affiliation(s)
- Takehiro Inoue
- Department of Cardiovascular Surgery, Mimihara General Hospital, Osaka, Japan
| | - Masato Imura
- Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka, Japan
| | - Toshio Kaneda
- Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka, Japan
| | - Toshihiko Saga
- Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka, Japan
| |
Collapse
|
40
|
Heuker M, Gomes A, van Dijl JM, van Dam GM, Friedrich AW, Sinha B, van Oosten M. Preclinical studies and prospective clinical applications for bacteria-targeted imaging: the future is bright. Clin Transl Imaging 2016; 4:253-264. [PMID: 27512688 PMCID: PMC4960279 DOI: 10.1007/s40336-016-0190-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/03/2016] [Indexed: 12/20/2022]
Abstract
Bacterial infections are a frequently occurring and major complication in human healthcare, in particular due to the rapid increase of antimicrobial resistance and the emergence of pan-drug-resistant microbes. Current anatomical and functional imaging modalities are insufficiently capable of distinguishing sites of bacterial infection from sterile inflammation. Therefore, definitive diagnosis of an infection can often only be obtained by tissue biopsy and subsequent culture and, occasionally, a definite diagnosis even appears to be impossible. To accurately diagnose bacterial infections early, novel imaging modalities are urgently needed. In this regard, bacteria-targeted imaging is an attractive option due to its specificity. Here, different bacteria-targeted imaging approaches are reviewed, and their promising future perspectives are discussed.
Collapse
Affiliation(s)
- Marjolein Heuker
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Anna Gomes
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jan Maarten van Dijl
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Gooitzen M. van Dam
- Department of Surgery, Division of Surgical Oncology, Nuclear Medicine and Molecular Imaging, Intensive Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Alexander W. Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Marleen van Oosten
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| |
Collapse
|
41
|
Glaudemans AW, Israel O, Slart RH. Pitfalls and Limitations of Radionuclide and Hybrid Imaging in Infection and Inflammation. Semin Nucl Med 2015; 45:500-12. [DOI: 10.1053/j.semnuclmed.2015.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
42
|
Fujii T, Watanabe Y. Multidisciplinary Treatment Approach for Prosthetic Vascular Graft Infection in the Thoracic Aortic Area. Ann Thorac Cardiovasc Surg 2015; 21:418-27. [PMID: 26356686 PMCID: PMC4904849 DOI: 10.5761/atcs.ra.15-00187] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 08/12/2015] [Indexed: 11/16/2022] Open
Abstract
Prosthetic vascular graft infection in the thoracic aortic area is a rare but serious complication. Adequate management of the complication is essential to increase the chance of success of open surgery. While surgical site infection is suggested as the root cause of the complication, it is also related to decreased host tolerance, especially as found in elderly patients. The handling of prosthetic vascular graft infection has been widely discussed to date. This paper mainly provides a summary of literature reports published within the past 5 years to discuss issues related to multidisciplinary treatment approaches, including surgical site infection, timing of onset, diagnostic methods, causative pathogens, auxiliary diagnostic methods, antibiotic treatment, anti-infective structures of vascular prostheses, surgical treatment, treatment strategy against infectious aortic aneurysms, future surgical treatment, postoperative systemic therapy, and antimicrobial stewardship. A thorough understanding of these issues will enable us to prevent prosthetic vascular graft infection in the thoracic aortic area as far as possible. In the event of its occurrence, the early introduction of appropriate treatment is expected to cure the disease without worsening of the underlying pathological condition.
Collapse
Affiliation(s)
- Takeshiro Fujii
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | | |
Collapse
|
43
|
Abstract
Owing to expanding clinical indications, cardiac implantable electronic devices (CIEDs) are being increasingly used. Despite improved surgical techniques and the use of prophylactic antimicrobial therapy, the rate of CIED-related infection is also increasing. Infection is a potentially serious complication, with clinical manifestations ranging from surgical site infection and local symptoms in the region of the generator pocket to fulminant endocarditis. The utility of radionuclide imaging as a stand-alone noninvasive diagnostic imaging test in patients with suspected endocarditis has been less frequently examined. This article summarizes the recent advances in radionuclide imaging for evaluation of patients with suspected cardiovascular infections.
Collapse
Affiliation(s)
- Fozia Zahir Ahmed
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Jackie James
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Matthew J Memmott
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK.
| |
Collapse
|
44
|
Yoo JR, Heo ST, Kim M, Kim HW, Chang JW, Song H. Arteriovenous fistula stent infection diagnosed with radiolabelled leucocyte scintigraphy. Infect Dis (Lond) 2015; 47:510-4. [DOI: 10.3109/00365548.2014.1002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
45
|
Chang CY, Chang CP, Shih CC, Yang BH, Cheng CY, Chang CW, Chu LS, Wang SJ, Liu RS. Added Value of Dual-Time-Point 18F-FDG PET/CT With Delayed Imaging for Detecting Aortic Graft Infection: An Observational Study. Medicine (Baltimore) 2015; 94:e1124. [PMID: 26166113 PMCID: PMC4504531 DOI: 10.1097/md.0000000000001124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
F-FDG PET/CT is a promising tool in detecting aortic graft infection. Present study investigated the value of dual-time-point F-FDG PET/CT imaging (DTPI) with delayed imaging in assessing aortic graft infection.Twenty-nine patients with suspected aortic graft infection were prospectively enrolled in this DTPI study. Two nuclear medicine physicians read all the images and achieved consensus about the measurement of maximal standardized uptake value (SUVmax) and grading of image quality. The percentages of SUVmax change between initial and delayed images were recorded as retention index (RI); sensitivity, specificity, and accuracy were calculated based on reference standard.All the 5 infected aortic grafts had positive RIs, which were generally higher than that of noninfected grafts. Those noninfected grafts had variable RIs. Seven patients had improved image quality in delayed imaging. DTPI with delayed image detected all the infected grafts with improved specificity (88%) and accuracy (90%), providing conspicuous delineation of the infected graft extent.In conclusion, noninfected aortic grafts had more variable RIs than infected ones. DTPI might be useful for detecting aortic graft infection, improving image quality, and enhancing delineation of the infected aortic grafts.
Collapse
Affiliation(s)
- Chih-Yung Chang
- From the School of Medicine, National Defense Medical Center, Taipei, Taiwan (C-YC, C-YiC, R-SL); Department of Nuclear Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C-YC, C-PC, B-HY, C-WC, L-SC, S-JW, R-SL); Division of Cardiovascular Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C-CS); Department of Nuclear Medicine, Tri-Service General Hospital, Taipei, Taiwan (C-YiC); and Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (C-YC, R-SL)
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
|