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Sebastian SA, Co EL, Mehendale M, Sudan S, Manchanda K, Khan S. Challenges and Updates in the Diagnosis and Treatment of Infective Endocarditis. Curr Probl Cardiol 2022; 47:101267. [DOI: 10.1016/j.cpcardiol.2022.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
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18F-FDG PET/CT in cardiovascular infection and inflammation. Rev Esp Med Nucl Imagen Mol 2021; 40:397-408. [PMID: 34627726 DOI: 10.1016/j.remnie.2021.09.008] [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: 08/31/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
Abstract
The diagnosis of cardiovascular infection and inflammation by [18F]FDG PET/CT in Nuclear Cardiology is of growing interest, because with respect to echocardiography this technique has improved the certainty in the diagnosis of infective endocarditis in patients with prosthetic valves, the increasing number of patients with implantable cardiac devices because of the progressive ageing of the population, as well as in patients with suspected large vessel vasculitis. All are serious clinical situations which require correct diagnosis and appropriate treatment as soon as possible, because they can cause severe complications, high mortality and also increased health care costs. We review the use of [18F]FDG PET/CT in cardiovascular infection and inflammation, including the clinical point of view and the contribution of other image modalities. We focus on the appropriate methodology for this exploration, patient preparation, image acquisition and correct interpretation and the quantification possibilities, defining the specific characteristics of the diagnosis in patients with prosthetic valves, implantable cardiac devices and large vessel vasculitis in the initial diagnosis as well as during follow-up to assess treatment response. We analyze the possible causes of false positive and false negative results and emphasize the special value of a multidisciplinary team for optimal management of these patients.
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Malik SB, Hsu JY, Hurwitz Koweek LM, Ghoshhajra BB, Beache GM, Brown RKJ, Davis AM, Johri AM, Kligerman SJ, Litmanovich D, Mace SE, Maroules CD, Meyersohn N, Villines TC, Wann S, Weissman G, Abbara S. ACR Appropriateness Criteria® Infective Endocarditis. J Am Coll Radiol 2021; 18:S52-S61. [PMID: 33958118 DOI: 10.1016/j.jacr.2021.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
Infective endocarditis can involve a normal, abnormal, or prosthetic cardiac valve. The diagnosis is typically made clinically with persistently positive blood cultures, characteristic signs and symptoms, and echocardiographic evidence of valvular vegetations or valvular complications such as abscess, dehiscence, or new regurgitation. Imaging plays an important role in the initial diagnosis of infective endocarditis, identifying complications, prognostication, and informing the next steps in therapy. This document outlines the initial imaging appropriateness of a patient with suspected infective endocarditis and for additional imaging in a patient with known or suspected infective endocarditis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Sachin B Malik
- Research Author, VA Palo Alto Health Care System, Palo Alto, California and Stanford University, Stanford, California, Section Chief Thoracic and Cardiovascular Imaging, Director of Stress Cardiac MRI Program, Director of Cardiovascular CT and MRI.
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | - Lynne M Hurwitz Koweek
- Panel Chair, Duke University Medical Center, Durham, North Carolina, Director, Cardiovascular Imaging, Medical Director of CT, Duke University Medical Center
| | | | - Garth M Beache
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Richard K J Brown
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, Utah
| | - Andrew M Davis
- The University of Chicago Medical Center, Chicago, Illinois, American College of Physicians
| | - Amer M Johri
- Queen's University, Kingston, Ontario, Canada, Cardiology expert
| | | | - Diana Litmanovich
- Harvard Medical School, Boston, Massachusetts, Section Chief of the Cardiothoracic Section, Department of Radiology, Beth Israel Deaconess Medical Center; President of the North American Society for Cardiovascular Imaging and Co-Chair of Image Wisely
| | - Sharon E Mace
- Cleveland Clinic, Cleveland, Ohio, American College of Emergency Physicians
| | | | | | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia, Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Ascension Healthcare Wisconsin, Milwaukee, Wisconsin, Nuclear cardiology expert
| | - Gaby Weissman
- Medstar Washington Hospital Center, Georgetown University, Washington, District of Columbia, Society for Cardiovascular Magnetic Resonance, Medstar Heart and Vascular Institute, Associate Professor of Medicine and Radiology
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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Huang YC, Hsu CC, Wu YC, Chen HJ, Chiu NT. Effect of fasting duration on myocardial fluorodeoxyglucose uptake in diabetic and nondiabetic patients. Nucl Med Commun 2021; 42:300-305. [PMID: 33306629 DOI: 10.1097/mnm.0000000000001339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To detect cardiac hypermetabolic lesions using fluorodeoxyglucose (FDG) with PET/computed tomography (PET/CT), the efficiency of long fasting and temperature condition for lowering physiological myocardial FDG uptake is controversial and may be confounded by other factors. We thus aimed to investigate the impact of fasting duration and ambient temperature on myocardial uptake in diabetic and nondiabetic patients. METHODS FDG PET/CT scans (n = 666) were reviewed and the myocardial uptake was visually graded on a four-point scale and quantified using standardized uptake value (SUV). The associations between myocardial uptake and fasting duration, diabetes status, ambient temperature parameters, age, gender, and BMI were evaluated. RESULTS Intraobserver [κ = 0.94; intraclass correlation coefficient (ICC) = 0.99] and interobserver (κ = 0.91; ICC = 0.99) reliabilities of both visual and SUV measurements were all excellent. Fasting duration and diabetes status were found to be significantly associated with myocardial FDG uptake, but the ambient temperature parameters and other factor were not. Patients with intense (Grade 4) myocardial uptake had a shorter fasting duration (P = 0.011). The SUVmax of myocardium was significantly higher in nondiabetic than diabetic patients (P < 0.001). Fasting duration ≥ 12 h in diabetic and ≥16 h in nondiabetic patients was associated with low prevalence of Grade 4 uptake (4.2%, P = 0.016; 2.3%, P = 0.028). CONCLUSION Fasting for long enough durations but not ambient temperature was associated with decreased physiological myocardial FDG uptake. A fasting duration of more than 12 h for diabetic, 16 h for nondiabetic patients is a simple and valuable recommendation.
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Affiliation(s)
- Yung-Cheng Huang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chien-Chin Hsu
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Yi-Chen Wu
- Department of Nuclear Medicine, E-Da Hospital
- Department of Medical Imaging and Radiological Sciences
- Department of Information Engineering, I-Shou University, Kaohsiung
| | - Hong-Jie Chen
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Nan-Tsing Chiu
- Department of Nuclear Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Philip M, Delcourt S, Mancini J, Tessonnier L, Cammilleri S, Arregle F, Martel H, Oliver L, Hubert S, Renard S, Camoin L, Casalta AC, Casalta JP, Gouriet F, Riberi A, Lepidi H, Collart F, Raoult D, Drancourt M, Habib G. 18F-fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of native valve infective endocarditis: A prospective study. Arch Cardiovasc Dis 2021; 114:211-220. [PMID: 33495137 DOI: 10.1016/j.acvd.2020.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/31/2020] [Accepted: 10/06/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) has recently been added as a major criterion in the European Society of Cardiology (ESC) 2015 infective endocarditis guidelines. PET/CT is currently used in patients with suspected prosthetic valve and cardiac device-related endocarditis. However, the value of the ESC classification and the clinical impact of PET findings are unknown in patients with native valve endocarditis (NVE). AIMS Our aims were: to assess the value of the ESC criteria (including PET/CT) in NVE; to determine the usefulness of PET/CT concerning embolic detection; and to describe a new PET/CT feature (diffuse splenic uptake). METHODS Between 2012 and 2017, 75 patients with suspected NVE were included prospectively, after exclusion of patients with uninterpretable or unfeasible PET/CT. Using gold standard expert consensus, 63 cases of infective endocarditis were confirmed and 12 were rejected. RESULTS Significant valvular uptake was observed in 11 of 63 patients with definite NVE and in no patients who had the diagnosis of infective endocarditis rejected (sensitivity 17.5%, specificity 100%). Among the 63 patients with NVE, a peripheral embolism or mycotic aneurysm was observed in 20 (31.7%) cases. Application of the ESC criteria increased Duke criteria sensitivity from 63.5% to 69.8% (P<0.001), without a change in specificity. Diffuse splenic uptake was observed in 39 (52.0%) patients, including 37 (58.7%) with a final diagnosis of NVE (specificity 83.3%). CONCLUSIONS 18F-FDG PET/CT has poor sensitivity but high specificity in the diagnosis of NVE. The usefulness of 18F-FDG PET/CT is high for embolic detection. Diffuse splenic uptake represents a possible new diagnostic criterion for NVE.
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Affiliation(s)
- Mary Philip
- Cardiology department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Sarkis Delcourt
- Department of nuclear medicine, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Julien Mancini
- Sciences économiques & sociales de la santé & traitement de l'information médicale (SESSTIM), Aix-Marseille University, INSERM, IRD, 13005 Marseille, France; Service biostatistique et technologies de l'information et de la communication, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Laetitia Tessonnier
- Department of nuclear medicine, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Serge Cammilleri
- Department of nuclear medicine, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Florent Arregle
- Cardiology department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Hélène Martel
- Cardiology department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Leopold Oliver
- Cardiology department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Sandrine Hubert
- Cardiology department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Sébastien Renard
- Cardiology department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Laurence Camoin
- IHU-Méditerranée Infection, Aix-Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France
| | | | - Jean Paul Casalta
- IHU-Méditerranée Infection, Aix-Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France
| | - Frédérique Gouriet
- IHU-Méditerranée Infection, Aix-Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France
| | - Alberto Riberi
- Department of cardiac surgery, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Hubert Lepidi
- IHU-Méditerranée Infection, Aix-Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France
| | - Frederic Collart
- Department of cardiac surgery, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Aix-Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France
| | - Michel Drancourt
- IHU-Méditerranée Infection, Aix-Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France
| | - Gilbert Habib
- Cardiology department, La Timone Hospital, AP-HM, 13005 Marseille, France; IHU-Méditerranée Infection, Aix-Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France.
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Crean AM, Ahmed F, Motwani M. The Role of Radionuclide Imaging in Congenital Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9434-0] [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]
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Fagman E, Bech-Hanssen O, Flinck A, Lamm C, Svensson G. Increased aortic wall thickness on CT as a sign of prosthetic valve endocarditis. Acta Radiol 2016; 57:1476-1482. [PMID: 26853686 DOI: 10.1177/0284185116628336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Increased wall thickness in the aortic root has been suggested as an early sign of prosthetic valve endocarditis (PVE). However, there are no previous studies on the aortic wall thickness after aortic valve replacement (AVR) or in patients with PVE. Purpose To identify a clinically useful cutoff value for aortic wall thickness to detect PVE. Material and Methods Chest computed tomography (CT) studies (n = 303) on patients with a prosthetic aortic valve were retrospectively analyzed. CT studies on patients without PVE (n = 260) were compared with CT studies on patients with definite PVE (n = 43). A receiver operator characteristic (ROC) analysis was performed. Results In non-PVE patients, the wall thickness during the first 3 months postoperatively (n = 70, 4.5 ± 1.7 mm) was increased compared to beyond 3 months postoperatively (n = 190, 3.2 ± 1.0 mm, P < 0.001). Beyond 3 months postoperatively, the wall thickness 95th percentile was 5.0 mm without signs of further decrease with time. The wall thickness in PVE patients was 6.8 ± 3.0 mm (n = 43). Beyond 3 months postoperatively, ROC analysis yielded an area under the curve of 0.89 (95% CI, 0.81-0.96). With a cutoff value of 5 mm the sensitivity was 67%, specificity 95%, positive likelihood ratio 14.1, and negative likelihood ratio 0.35 of increased wall thickness in detecting PVE. Conclusion In the early postoperative period after AVR, the aortic wall thickness is increased compared to the late postoperative period. After 3 months, the wall thickness has decreased and stabilized. Increased wall thickness (>5 mm) beyond 3 months postoperatively significantly increases the likelihood of PVE.
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Affiliation(s)
- Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Agneta Flinck
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Carl Lamm
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Gunnar Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Clinical Utility and Future Applications of PET/CT and PET/CMR in Cardiology. Diagnostics (Basel) 2016; 6:diagnostics6030032. [PMID: 27598207 PMCID: PMC5039566 DOI: 10.3390/diagnostics6030032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/17/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022] Open
Abstract
Over the past several years, there have been major advances in cardiovascular positron emission tomography (PET) in combination with either computed tomography (CT) or, more recently, cardiovascular magnetic resonance (CMR). These multi-modality approaches have significant potential to leverage the strengths of each modality to improve the characterization of a variety of cardiovascular diseases and to predict clinical outcomes. This review will discuss current developments and potential future uses of PET/CT and PET/CMR for cardiovascular applications, which promise to add significant incremental benefits to the data provided by each modality alone.
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Orvin K, Goldberg E, Bernstine H, Groshar D, Sagie A, Kornowski R, Bishara J. The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis. Clin Microbiol Infect 2014; 21:69-76. [PMID: 25636930 DOI: 10.1016/j.cmi.2014.08.012] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/17/2014] [Accepted: 08/05/2014] [Indexed: 01/27/2023]
Abstract
The exact incidence of extra-cardiac complications (ECC) in patients with infective endocarditis (IE) is unknown but presumed to be high. These patients, although mostly asymptomatic, may require a more aggressive therapeutic approach. (18)fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used for the diagnosis of infections, but its role in the early diagnosis of IE complications is still unclear. This study aimed to evaluate the role of FDG-PET/CT in the early diagnosis of ECC in IE and its implications for medical management. We prospectively studied 40 consecutive patients with a confirmed diagnosis of IE (according to the modified Duke criteria) who underwent a whole body FDG-PET/CT study within 14 days from diagnosis. The FDG-PET/CT demonstrated ECC in 17 (42.5%) patients, while 8 (38.1%) of them were asymptomatic. The most frequent embolic sites were musculoskeletal and splenic. Owing to the FDG-PET/CT findings, treatment planning was modified in 14 (35%) patients. This included antibiotic treatment prolongation (27.5%), referral to surgical procedures (15%) and, most substantially, prevention of unnecessary device extraction (17.7%). According to our experiences, FDG-PET/CT imaging was useful in the detection of embolic and metastatic infections in IE. This clinical information had a significant diagnostic and therapeutic impact in managing IE disease.
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Affiliation(s)
- K Orvin
- Cardiology Department, Rabin Medical Centre, Petach Tikva, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - E Goldberg
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Rabin Medical Centre, Petach Tikva, Israel
| | - H Bernstine
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Nuclear Medicine Department, Rabin Medical Centre, Petach Tikva, Israel
| | - D Groshar
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Nuclear Medicine Department, Rabin Medical Centre, Petach Tikva, Israel
| | - A Sagie
- Cardiology Department, Rabin Medical Centre, Petach Tikva, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Kornowski
- Cardiology Department, Rabin Medical Centre, Petach Tikva, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Bishara
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Rabin Medical Centre, Petach Tikva, Israel
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Ricciardi A, Sordillo P, Ceccarelli L, Maffongelli G, Calisti G, Di Pietro B, Caracciolo CR, Schillaci O, Pellegrino A, Chiariello L, Andreoni M, Sarmati L. 18-Fluoro-2-deoxyglucose positron emission tomography-computed tomography: an additional tool in the diagnosis of prosthetic valve endocarditis. Int J Infect Dis 2014; 28:219-24. [PMID: 25093540 DOI: 10.1016/j.ijid.2014.04.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/20/2014] [Accepted: 04/26/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To evaluate the role of 18-fluoro-2-deoxyglucose positron emission tomography-computed tomography ((18)F-FDG-PET-CT) in the diagnosis of infectious endocarditis (IE). METHODS We retrospectively examined 27 consecutive patients who were admitted to the Infectious Diseases Department of Tor Vergata University Hospital between 2009 and 2013 with a suspicion of IE. The final IE diagnosis was defined according to the modified Duke criteria, and the microbiological and diagnostic results were collected for each patient. RESULTS Twenty out of 27 patients had a suspected prosthetic valve endocarditis (PVE) and seven had a suspected native valve endocarditis (NVE). Twenty-five out of 27 patients (92%) had a confirmed diagnosis of IE (18/25 PVE and 7/25 NVE); 16 had a positive echocardiography evaluation and 16 had positive (18)F-FDG-PET-CT findings. Echocardiography showed a higher sensitivity as a diagnostic tool for the detection of IE compared to (18)F-FDG-PET-CT (80% vs. 55%). However, a greater number of PVE had positive (18)F-FDG-PET-CT results compared to those with positive echocardiography findings (11/13 vs. 9/13), and overall 89% (16/18) of confirmed PVE resulted (18)F-FDG-PET-CT positive. Analyzing only the cases who underwent transoesophageal echocardiography, (18)F-FDG-PET-CT showed a sensitivity of 85% in PVE (vs. 69% for echocardiography and 77% for the Duke criteria). All seven patients with NVE had a positive echocardiography and negative (18)F-FDG-PET-CT findings (p<0.001). CONCLUSIONS The results of this study further highlight the limitations of echocardiography in the diagnosis of PVE and the potential advantages of (18)F-FDG-PET-CT in these cases.
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Affiliation(s)
- Alessandra Ricciardi
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Pasquale Sordillo
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Laura Ceccarelli
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Gaetano Maffongelli
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Giorgio Calisti
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
| | - Barbara Di Pietro
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Rome, Italy
| | | | - Orazio Schillaci
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Rome, Italy
| | | | | | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy.
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Eggleston H, Panizzi P. Molecular imaging of bacterial infections in vivo: the discrimination of infection from inflammation. INFORMATICS (MDPI) 2014; 1:72-99. [PMID: 26985401 PMCID: PMC4790455 DOI: 10.3390/informatics1010072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Molecular imaging by definition is the visualization of molecular and cellular processes within a given system. The modalities and reagents described here represent a diverse array spanning both pre-clinical and clinical applications. Innovations in probe design and technologies would greatly benefit therapeutic outcomes by enhancing diagnostic accuracy and assessment of acute therapy. Opportunistic pathogens continue to pose a worldwide threat, despite advancements in treatment strategies, which highlights the continued need for improved diagnostics. In this review, we present a summary of the current clinical protocol for the imaging of a suspected infection, methods currently in development to optimize this imaging process, and finally, insight into endocarditis as a model of infectious disease in immediate need of improved diagnostic methods.
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Affiliation(s)
- Heather Eggleston
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849
| | - Peter Panizzi
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849
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Abstract
Cardiac infections include a group of conditions involving the heart muscle, the pericardium, or the endocardial surface of the heart. Infections can extend to prosthetic material or the leads in case of the implantation of devices. Despite their relative low incidence, these conditions that are associated with high morbidity and mortality involve a relevant burden of diagnostic workup. Early diagnosis is crucial for adequate management of patient, as early treatment improves the prognosis; unfortunately, the clinical manifestations are often nonspecific. Accurate and timely diagnosis typically requires the correlation of imaging findings with laboratory data. (18)F-FDG-PET is a well-established imaging modality for the diagnosis and management of malignancies, and evidence is also increasing regarding its value for assessing infectious and inflammatory diseases. This article summarizes published evidence on the usefulness of (18)F-FDG-PET for the diagnosis of cardiac infections, mainly focused on endocarditis and cardiovascular device infections. Nevertheless, the diagnostic potential of (18)F-FDG-PET in patients with pericarditis and myocarditis is also briefly reviewed, considering the most likely future advances and new perspectives that the use of PET/magnetic resonance would open in the diagnosis of such conditions.
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Affiliation(s)
- Paola A Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy.
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Abstract
This article describes the normal patterns of thoracic (18)F-fluorodeoxyglucose (FDG) biodistribution, and expands on the role of FDG-PET/computed tomography (CT) for the evaluation of patients suffering from a spectrum of benign pathologic conditions that affect the chest. The discussion addresses the applications of FDG-PET/CT imaging in a wide variety of chest-related disorders. Familiarity with the normal thoracic biodistribution of FDG, coupled with knowledge of the potential nonmalignant causes of increased FDG uptake in the chest, is essential to minimize the incidence of incorrect interpretation of FDG-PET images in daily clinical practice.
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Millar BC, Prendergast BD, Alavi A, Moore JE. 18FDG-positron emission tomography (PET) has a role to play in the diagnosis and therapy of infective endocarditis and cardiac device infection. Int J Cardiol 2013; 167:1724-36. [DOI: 10.1016/j.ijcard.2012.12.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/19/2012] [Accepted: 12/01/2012] [Indexed: 12/15/2022]
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Jenkins WSA, Chin C, Rudd JHF, Newby DE, Dweck MR. What can we learn about valvular heart disease from PET/CT? Future Cardiol 2013; 9:657-67. [DOI: 10.2217/fca.13.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Valvular heart disease is a major cause of morbidity and mortality, and with an aging population, its prevalence is increasing. Here, we review the evolving use of positron emission tomography/computed tomography in valvular heart disease, with particular focus on calcific aortic stenosis and infective endocarditis. In principle, the activity of any pathological process can be studied, as long as an appropriate radiotracer can be developed. We will review some of the early data using established tracers in the above and other conditions, providing discussion as to the future research and clinical roles of these techniques. Furthermore, we will discuss the potential impact of novel tracers that are currently under development or testing in preclinical models. It is hoped that such advanced imaging might improve the diagnosis, treatment and outlook for patients with valvular heart disease.
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Affiliation(s)
- William SA Jenkins
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Calvin Chin
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
- National Heart Center Singapore, SingHealth, Singapore
| | - James HF Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
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The value of 18F-FDG PET/CT in diagnosing infectious endocarditis. Eur J Nucl Med Mol Imaging 2013; 40:1102-7. [PMID: 23471580 DOI: 10.1007/s00259-013-2376-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 02/13/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Early detection of infectious endocarditis is challenging. For diagnosing infectious endocarditis, the revised Duke criteria are the gold standard. Evidence of endocardial involvement on echocardiography is a major criterion, but sensitivity and specificity of echocardiography are not optimal. Here we investigated the utility of (18)F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) to diagnose infectious endocarditis in patients with gram-positive bacteraemia. METHODS Seventy-two patients with gram-positive bacteraemia were prospectively included. Patients with a positive blood culture growing Staphylococcus aureus, Streptococcus species or Enterococcus species were eligible when a risk factor for developing metastatic infectious foci was present. Infectious endocarditis was defined according to the revised Duke criteria. All patients underwent (18)F-FDG PET/CT and echocardiography. (18)F-FDG uptake in or around the heart valves was evaluated independently by two nuclear medicine physicians. RESULTS Sensitivity for diagnosing infectious endocarditis with (18)F-FDG PET/CT was 39% and specificity was 93%. The positive predictive value was 64% and negative predictive value was 82%. The mortality rate in patients without infectious endocarditis and without increased (18)F-FDG uptake in or around the heart valves was 18%, and in patients without infectious endocarditis but with high (18)F-FDG uptake in or around the heart valves the mortality rate was 50% (p = 0.181). CONCLUSION (18)F-FDG PET/CT is currently not sufficiently adequate for the diagnosis of infectious endocarditis because of its low sensitivity. Improvements such as patient preparation with low carbohydrate-fat allowed diet and technical advances in the newest PET/CT scanners may increase sensitivity in future studies.
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Palestro CJ, Love C. Decreased sensitivity of (18)F-fluorodeoxyglucose imaging in infection and inflammation. Semin Nucl Med 2013; 42:261-6. [PMID: 22681675 DOI: 10.1053/j.semnuclmed.2012.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nuclear medicine plays an important role in the evaluation of inflammation and infection. Although (99m)Tc-methylene diphosphonate, (67)Ga-citrate, and in vitro labeled autologous leukocyte imaging are useful procedures, there are limitations to each of them. (18)F-fluorodeoxyglucose-positron-emission tomography (PET) and PET/computed tomography offer several advantages over conventional single-photon-emitting tracers and has proved to be a valuable addition to the nuclear medicine infection imaging armamentarium. PET provides high-resolution 3-dimensional images of the whole body that facilitates precise localization of abnormalities. Localization is enhanced with PET/computed tomography. Fluorodeoxyglucose, for the most part, is exquisitely sensitive with a high negative predictive value. In general, the limiting factor of the test is specificity. However, there are some situations in which the limitation to the test is not low specificity but rather low sensitivity.
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Affiliation(s)
- Christopher J Palestro
- Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
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Thuny F, Gaubert JY, Jacquier A, Tessonnier L, Cammilleri S, Raoult D, Habib G. Imaging investigations in infective endocarditis: Current approach and perspectives. Arch Cardiovasc Dis 2013; 106:52-62. [DOI: 10.1016/j.acvd.2012.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/08/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
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20
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Nononcological Applications of Positron Emission Tomography for Evaluation of the Thorax. J Thorac Imaging 2013; 28:25-39. [DOI: 10.1097/rti.0b013e31827882a9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Wallner M, Steyer G, Krause R, Gstettner C, von Lewinski D. Fungal endocarditis of a bioprosthetic aortic valve. Herz 2012; 38:431-4. [DOI: 10.1007/s00059-012-3715-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 10/09/2012] [Accepted: 10/11/2012] [Indexed: 11/28/2022]
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22
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Cardiac 18F-FDG PET/CT With Heparin Detects Infective Vegetation in a Patient With Mechanical Valve Replacement. Clin Nucl Med 2012; 37:1184-5. [DOI: 10.1097/rlu.0b013e318251e3f4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Spectrum of physiological and pathological cardiac and pericardial uptake of FDG in oncology PET-CT. Clin Radiol 2012. [PMID: 23177651 DOI: 10.1016/j.crad.2012.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiac uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) is frequently observed on FDG positron-emission tomography combined with computed tomography (PET-CT) performed for diagnosis, staging, and assessment of therapeutic response of lymphoma and solid cancers, despite careful patient preparation to limit myocardial glucose substrate utilisation. We illustrate the varied physiological patterns of cardiac FDG uptake, and show a spectrum of pathological conditions causing FDG uptake within myocardial and pericardial structures, due to clinically important benign and malignant diseases. Recognition and awareness of these various causes of FDG uptake in the heart, along with the appropriate use of correlative contrast-enhanced CT and magnetic resonance imaging (MRI) will facilitate correct interpretation.
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24
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El Hajjaji I, Mansencal N, Dubourg O. Diagnosis of Cardiobacterium hominis endocarditis: Usefulness of positron emission tomography. Int J Cardiol 2012; 160:e3-4. [DOI: 10.1016/j.ijcard.2011.12.092] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 12/24/2011] [Indexed: 11/24/2022]
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25
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Antimicrobial peptides as infection imaging agents: better than radiolabeled antibiotics. INTERNATIONAL JOURNAL OF PEPTIDES 2012; 2012:965238. [PMID: 22675369 PMCID: PMC3362861 DOI: 10.1155/2012/965238] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 02/09/2012] [Accepted: 03/11/2012] [Indexed: 11/17/2022]
Abstract
Nuclear medicine imaging techniques offer whole body imaging for localization of number and site of infective foci inspite of limitation of spatial resolution. The innate human immune system contains a large member of important elements including antimicrobial peptides to combat any form of infection. However, development of antibiotics against bacteria progressed rapidly and gained popularity over antimicrobial peptides but even powerful antimicrobials failed to reduce morbidity and mortality due to emergence of mutant strains of bacteria resulting in antimicrobial resistance. Differentiation between infection and inflammation using radiolabeled compounds with nuclear medicine techniques has always been a dilemma which is still to be resolved. Starting from nonspecific tracers to specific radiolabeled tracers, the question is still unanswered. Specific radiolabeled tracers included antibiotics and antimicrobial peptides which bind directly to the bacteria for efficient localization with advanced nuclear medicine equipments. However, there are merits and demerits attributed to each. In the current paper, radiolabeled antibiotics and radiolabeled peptides for infection localization have been discussed starting with the background of primitive nonspecific tracers. Radiolabeled antimicrobial peptides have certain merits compared with labeled antibiotics which make them superior agents for localization of infective focus.
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26
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Xu B, Liu Y, Codreanu I. Utilization of FDG PET/CT in the Management of Inflammation and Infection in Patients with Malignancies. PET Clin 2012; 7:211-8. [DOI: 10.1016/j.cpet.2012.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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28
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Maurer AH, Burshteyn M, Adler LP, Steiner RM. How to differentiate benign versus malignant cardiac and paracardiac 18F FDG uptake at oncologic PET/CT. Radiographics 2012; 31:1287-305. [PMID: 21918045 DOI: 10.1148/rg.315115003] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients undergoing 2-[fluorine 18]fluoro-2-deoxy-d-glucose (FDG) whole-body oncologic positron emission tomography (PET)/computed tomography (CT) are studied while fasting. Cardiac FDG uptake in fasted patients has been widely reported as variable. It is important to understand the normal patterns of cardiac FDG activity that can be seen in oncologic FDG PET/CT studies. These include focal and regional patterns of increased FDG myocardial activity. Focal activity can be observed in papillary muscles, the atria, the base, and the distal anteroapical region of the left ventricle. Regional increased cardiac FDG activity may be diffuse or localized in the posterolateral wall or the base of the left ventricle. Abnormal patterns of cardiac FDG activity not related to malignancy include those associated with lipomatous hypertrophy of the interatrial septum, epicardial and pericardial fat, increased atrial activity associated with atrial fibrillation or a prominent crista terminalis, cardiac sarcoidosis, endocarditis, myocarditis, and pericarditis. Knowledge of these patterns of cardiac FDG activity is important to be able to recognize malignant disease involving the paracardiac spaces, myocardium, and pericardium. With a better understanding of the range of normal and abnormal patterns of cardiac FDG activity, important benign and malignant diseases involving the heart and pericardium can be recognized and diagnosed.
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Affiliation(s)
- Alan H Maurer
- Department of Radiology, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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29
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Khan RS, Schulze PC, Bokhari S, Goldberg IJ. A sweet heart: increased cardiac glucose uptake in patients with lipoprotein lipase deficiency. J Nucl Cardiol 2011; 18:1107-10. [PMID: 21845510 PMCID: PMC3454484 DOI: 10.1007/s12350-011-9442-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Raffay S Khan
- Division of Preventive Medicine and Nutrition, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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30
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Possible role of F18-FDG-PET/CT in the diagnosis of endocarditis: preliminary evidence from a review of the literature. Int J Cardiovasc Imaging 2011; 28:1417-25. [DOI: 10.1007/s10554-011-9984-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 11/16/2011] [Indexed: 01/30/2023]
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31
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Yeh CL, Liou JY, Chen SW, Chen YK. Infective endocarditis detected by 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in a patient with occult infection. Kaohsiung J Med Sci 2011; 27:528-31. [DOI: 10.1016/j.kjms.2011.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 10/08/2010] [Indexed: 10/17/2022] Open
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Abstract
This Focus summarizes current and prospective roles of modern functional imaging techniques for detecting infection in general and endocarditis in particular.
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Affiliation(s)
- Abass Alavi
- Radiology Department, Division of Nuclear Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Babak Saboury
- Radiology Department, Division of Nuclear Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Sandip Basu
- Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Parel, Mumbai, 400012, India
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33
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Abstract
New aggressive pathogens are responsible for the increasing incidence and difficult management of infections. Modern epidemics such as diabetes are frequently complicated by severe infections with subsequent high morbidity. Diagnosis (essentially early detection of infection) and also management decision making pose clinical challenges. Many resources are invested in developing precise, noninvasive diagnostic tests and efficient therapies for infectious processes. Nuclear medicine procedures are part of the evaluation armamentarium of patients with suspected or confirmed infection. Their strength relies on the fact that they are noninvasive tests that provide both functional as well as metabolic information early in the course of disease. Their limitations relate to the need for specific radiotracers and the rather low resolution of images. These limitations have been largely overcome by the hybrid PET/CT and SPECT/CT technology. PET/CT, primarily using FDG, is redefining the diagnostic work up and is currently leading to changes in the management of patients with suspected or known infections. The main indications for FDG PET/CT in infection, as well as updated literature results, are presented in the following review.
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Affiliation(s)
- Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus and Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
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34
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Liu Y, Ghesani NV, Zuckier LS. Physiology and pathophysiology of incidental findings detected on FDG-PET scintigraphy. Semin Nucl Med 2010; 40:294-315. [PMID: 20513451 DOI: 10.1053/j.semnuclmed.2010.02.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A routine feature of positron emission tomography/computed tomography (PET/CT) imaging is whole-body acquisition that results in many unexpected findings identified outside of the primary region of abnormality. Furthermore, (18)F-fluorodeoxyglucose (FDG) is a marker of glycolysis and does not specifically accumulate in malignancy. Understanding the physiology and pathophysiology of normal FDG distribution and common incidental findings is therefore essential to the physician interpreting whole-body FDG-PET/CT studies. Whereas many incidental findings are benign and of limited clinical significance, others represent uncommon manifestations of the primary malignancy, second malignancies, or various clinically significant pathologic processes. Patients with a single malignancy are at greater risk of developing synchronous or metachronous second malignancies, possibly related to exposure to shared carcinogenic agents or presence of prooncogenic mutations. The decision of how to pursue an intervention on the basis of an incidental finding is generally left to clinical judgment.
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Affiliation(s)
- Yiyan Liu
- Nuclear Medicine Section, Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
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35
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Affiliation(s)
- Susanne Haase Vind
- Department of Nuclear Medicine, Naestved Hospital, DK-4700, Naestved, Denmark.
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36
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37
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Wang X, Koch S. Positron emission tomography/computed tomography potential pitfalls and artifacts. Curr Probl Diagn Radiol 2009; 38:156-69. [PMID: 19464586 DOI: 10.1067/j.cpradiol.2008.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the recent use of 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) for tumor staging and treatment response, it is important to recognize many pitfalls, artifacts, and benign uptakes that are commonly encountered. Normal physiology can explain many regions of increased FDG activity, as well as incidental benign tumors and benign metabolic conditions. Recognition of characterization of benign causes and physiologic variants for FDG uptake are discussed to avoid improper characterization as a malignancy. A basic understanding of PET/computed tomographic physics is also discussed, in relation to attenuation correction artifacts caused by metallic implants and contrast agents in the gastrointestinal tract, as well as artifacts caused in fused images due to patient motion. Also presented is the rationale for expected, benign uptake in various metabolic diseases, as well as pharmacologic methods for decreasing the artifacts caused by metabolic diseases. PET/computed tomographic evaluation of the thyroid, thymus, adrenal adenomas, uterus and ovaries, infection/inflammatory changes, and postradiation/chemotherapy changes are also discussed, with expected normal changes, as well as pitfalls and artifacts.
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Affiliation(s)
- Xia Wang
- Department of Radiology, Henry Ford Health System, Detroit, MI 48202-2689, USA
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38
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Lalonde L, Ziadi MC, Beanlands R. Cardiac positron emission tomography: current clinical practice. Cardiol Clin 2009; 27:237-55, Table of Contents. [PMID: 19306767 DOI: 10.1016/j.ccl.2008.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the last two decades, the field of nuclear cardiology has experienced significant progress. The introduction of positron emission tomography (PET) imaging represented a major breakthrough that has significantly contributed to a better understanding of physiology and pathophysiology of several heart diseases. Currently, PET imaging is recognized as a well-established method to assess cardiac perfusion, function, metabolism, and viability. This article summarizes the main clinical applications of state-of-the art cardiac PET technology.
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Affiliation(s)
- Lucille Lalonde
- Department of Medicine, Division of Cardiology, Mazinkowski Alberta Heart Institute, University of Alberta, 2C2 Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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39
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Basu S, Chryssikos T, Moghadam-Kia S, Zhuang H, Torigian DA, Alavi A. Positron Emission Tomography as a Diagnostic Tool in Infection: Present Role and Future Possibilities. Semin Nucl Med 2009; 39:36-51. [DOI: 10.1053/j.semnuclmed.2008.08.004] [Citation(s) in RCA: 197] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Bonardel G, Lecoules S, Mantzarides M, Carmoi T, Gontier E, Blade JS, Soret M, Foehrenbach H, Algayres JP. [Positron emission tomography in internal medicine]. Presse Med 2007; 37:460-9. [PMID: 17596908 DOI: 10.1016/j.lpm.2007.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 03/29/2007] [Accepted: 04/16/2007] [Indexed: 11/24/2022] Open
Abstract
FDG-PET is now an established diagnostic tool in oncology. Fluorodeoxyglucose is not a specific tracer for malignant lesions but rather for elevated glucose metabolism, present not only in cancer but also in inflammatory and infectious lesions. FDG-PET has thus been suggested for diagnosis of fevers of unknown origin, deep bone or visceral infectious foci, inflammatory vasculitis or sarcoidosis and unknown primary tumors, all frequent situation in internal medicine. The main characteristics of FDG-PET are its ability to rule out focal inflammation or infection with a high degree of certainty when the examination is negative because of its good negative predictive value and its usefulness as an early marker of therapeutic response, compared with anatomy-based or conventional scintigraphic imaging. Large-scale prospective studies are necessary, however, before FDG-PET is integrated into routine clinical use. It should be compared with different techniques already validated (biology, radiology, conventional scintigraphic imaging) and its cost-effectiveness should be evaluated.
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Affiliation(s)
- Gérald Bonardel
- Service de médecine nucléaire, HIA Val-de-Grâce, 74 Paris Cedex 05.
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41
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Cascini GL, De Palma D, Matteucci F, Biggi A, Rambaldi PF, Signore A, Mansi L. Fever of unknown origin, infection of subcutaneous devices, brain abscesses and endocarditis. Nucl Med Commun 2006; 27:213-22. [PMID: 16479240 DOI: 10.1097/00006231-200603000-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The term 'fever of unknown origin' includes a wide range of conditions that often remain undiagnosed. The possibility of an infection must be promptly diagnosed in order to begin appropriate therapy. Imaging with radiopharmaceuticals, computed tomography, magnetic resonance imaging and ultrasound are the most commonly applied techniques, usually performed in addition to blood tests, biopsies or tissue cultures when required. The lack of comparative studies investigating the accuracy of each radiopharmaceutical for the study of fever of unknown origin was the incentive to perform a meta-analysis of peer articles published between 1981 and 2004 (33 papers) describing the use of nuclear medicine imaging for this purpose. Furthermore, infection of subcutaneous devices, brain abscesses and endocarditis must be considered amongst the causes of fevers of unknown origin. Reviews of 23, 10 and 10 papers, respectively (from 1976 to 2005), were performed on these specific topics. The results may be a useful guide for the choice of the optimal radiopharmaceutical(s) and diagnostic strategy to be applied in each clinical condition and for different aims.
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42
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Kaneta T, Hakamatsuka T, Takanami K, Yamada T, Takase K, Sato A, Higano S, Kinomura S, Fukuda H, Takahashi S, Yamada S. Evaluation of the relationship between physiological FDG uptake in the heart and age, blood glucose level, fasting period, and hospitalization. Ann Nucl Med 2006; 20:203-8. [PMID: 16715951 DOI: 10.1007/bf03027431] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Positron emission tomography (PET) with fluorodeoxyglucose (FDG) is widely used for evaluation of cancer and ischemic heart disease. Recently, increased myocardial FDG uptake has been reported to be related to some types of heart disease, such as sarcoidosis. However, the physiological increased FDG uptake in the heart often mimics the abnormal high uptake in these cases. In this study, we investigated the relationships between myocardial uptake and age, blood glucose level, fasting period, and hospitalization status (inpatient vs. outpatient). METHODS A total of 159 non-diabetic patients were enrolled in the present study. Patients were imaged on a PET/CT scanner, and a three-dimensional region of interest (ROI) was drawn on the fused PET/CT image to measure the maximum standardized uptake value (SUV(max)) of the whole left ventricle. RESULTS No significant relationships were observed between myocardial uptake and age or fasting period. Blood glucose level showed a significant relationship (p = 0.025) with myocardial uptake, but the R-square was extremely small (r2 = 0.03). With an SUV(max) threshold of 3.0, there was no significant difference between inpatients and outpatients. However, outpatients showed a significantly higher frequency of myocardial uptake over SUV(max) of 5.0 (chi2 test: p = 0.046). CONCLUSION It is difficult to predict the degree of physiological uptake in the heart from data regarding age, fasting period, or blood glucose level. Outpatients tend to show higher myocardial uptake than inpatients, which may make it difficult to detect abnormally increased uptake in the heart. A long fasting period, such as overnight fasting, is an inadequate means to reduce the physiological uptake of FDG in the heart.
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Affiliation(s)
- Tomohiro Kaneta
- Department of Radiology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
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43
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Abstract
Nuclear medicine plays an important role in the evaluation of infection and inflammation. Fluorine 18 fluorodeoxyglucose (FDG) is a readily available radiotracer that offers rapid, exquisitely sensitive high-resolution tomography. In patients with acquired immunodeficiency syndrome, FDG positron emission tomography (PET) accurately helps localize foci of infection and is particularly useful for differentiating central nervous system lymphoma from toxoplasmosis. FDG PET can also help localize the source of fever of undetermined origin (FUO), thereby guiding additional testing. In the musculoskeletal system, FDG PET accurately helps diagnose spinal osteomyelitis, and in inflammatory conditions such as sarcoidosis and vasculitis, it appears to be useful for defining the extent of disease and monitoring response to treatment. FDG PET may be of limited usefulness in postoperative patients and in patients with a failed joint prosthesis or a tumor. Nevertheless, this relatively new imaging technique promises to be helpful in the diagnosis of infection and inflammation. FDG PET will likely assume increasing importance in assessing FUO, spinal osteomyelitis, vasculitis, and sarcoidosis and may even become the radionuclide imaging procedure of choice in the evaluation of some or all of these pathologic conditions.
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Affiliation(s)
- Charito Love
- Division of Nuclear Medicine, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA.
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