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Singh H, Alam A, Tilak TVSVGK, Kinra P, Soni BK. Pitfalls in interpretation of FDG PET/CT: Septic pulmonary emboli mimicking metastases in a case of gastric carcinoma. Indian J Radiol Imaging 2021; 26:524-527. [PMID: 28104952 PMCID: PMC5201088 DOI: 10.4103/0971-3026.195792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammatory lesions may sometimes show intense tracer uptake and mimic neoplastic lesions on (18) F-fluoro-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). We report one such false positive case on FDG PET/CT, where septic pulmonary emboli (SPE) mimicked pulmonary metastases. A 45-year-old man with stomach cancer had an indwelling central venous catheter (CVC) in situ while on neoadjuvant chemotherapy. He underwent FDG PET/CT scan for response assessment and the images revealed multiple, intensely FDG avid, peripheral, lung nodules with feeding vessels, which were suspicious for pulmonary metastases. A day later, the patient developed fever with chills and his blood culture showed bacterial growth (Enterobacter cloacae). A provisional diagnosis of SPE from an infected CVC was made. Chemotherapy was withheld, CVC removed, and the catheter tip was sent for bacterial culture. Following a 4-week course of antibiotic treatment, the patient became afebrile. Culture from the CVC tip grew the same organism, as was seen earlier in the patient's blood culture, thus pin-pointing the source of infection in our case. Diagnosis of SPE was clinched when follow-up CT chest done after completion of antibiotic course showed complete resolution of the lung lesions.
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Affiliation(s)
- Harkirat Singh
- Department of Nuclear Medicine, Command Hospital (AF), Bengaluru, Karnataka, India
| | - Aftab Alam
- Department of Radiology, Command Hospital (AF), Bengaluru, Karnataka, India
| | - T V S V G K Tilak
- Department of Medical Oncology, Command Hospital (AF), Bengaluru, Karnataka, India
| | - Prateek Kinra
- Department of Pathology, Command Hospital (AF), Bengaluru, Karnataka, India
| | - Brijesh K Soni
- Department of Radiology, Command Hospital (AF), Bengaluru, Karnataka, India
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Pozo E, Olmos C, de Agustín JA, Jiménez-Ballvé A, Pérez de Isla L, Macaya C. Avances en el diagnóstico por imagen de la endocarditis infecciosa izquierda. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Dutta J, Naicker T, Ebenhan T, Kruger HG, Arvidsson PI, Govender T. Synthetic approaches to radiochemical probes for imaging of bacterial infections. Eur J Med Chem 2017; 133:287-308. [DOI: 10.1016/j.ejmech.2017.03.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 02/08/2023]
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Salomäki SP, Saraste A, Kemppainen J, Bax JJ, Knuuti J, Nuutila P, Seppänen M, Roivainen A, Airaksinen J, Pirilä L, Oksi J, Hohenthal U. 18F-FDG positron emission tomography/computed tomography in infective endocarditis. J Nucl Cardiol 2017; 24:195-206. [PMID: 26662063 DOI: 10.1007/s12350-015-0325-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The diagnosis of infective endocarditis (IE), especially the diagnosis of prosthetic valve endocarditis (PVE) is challenging since echocardiographic findings are often scarce in the early phase of the disease. We studied the use of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in IE. METHODS Sixteen patients with suspected PVE and 7 patients with NVE underwent visual evaluation of 18F-FDG-PET/CT. 18F-FDG uptake was measured also semiquantitatively as maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). The modified Duke criteria were used as a reference. RESULTS There was strong, focal 18F-FDG uptake in the area of the affected valve in all 6 cases of definite PVE, in 3 of 5 possible PVE cases, and in 2 of 5 rejected cases. In all patients with definite PVE, SUVmax of the affected valve was higher than 4 and TBR higher than 1.8. In contrast to PVE, only 1 of 7 patients with NVE had uptake of 18F-FDG by PET/CT in the valve area. Embolic infectious foci were detected in 58% of the patients with definite IE. CONCLUSIONS 18F-FDG-PET/CT appears to be a sensitive method for the detection of paravalvular infection associated with PVE. Instead, the sensitivity of PET/CT is limited in NVE.
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Affiliation(s)
- Soile Pauliina Salomäki
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Pirjo Nuutila
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Marko Seppänen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Anne Roivainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Juhani Airaksinen
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Laura Pirilä
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
| | - Jarmo Oksi
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Ulla Hohenthal
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland.
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Meyer Z, Fischer M, Koerfer J, Laser K, Kececioglu D, Burchert W, Ulrich S, Preuss R, Haas N. The role of FDG-PET-CT in pediatric cardiac patients and patients with congenital heart defects. Int J Cardiol 2016; 220:656-60. [DOI: 10.1016/j.ijcard.2016.06.109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/27/2016] [Accepted: 06/21/2016] [Indexed: 12/19/2022]
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Pichon M, Mikail N, Ben Ali K, Rouzet F, Burdet C, Yazdanpanah Y, Joly V, Lepage L, Sarda-Mantel L. 18FDG-PET/CT: a useful tool for the management of patients in infectious diseases. Infect Dis (Lond) 2016; 49:155-157. [PMID: 27619910 DOI: 10.1080/23744235.2016.1227084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Maud Pichon
- a Service de Maladies Infectieuses et Tropicales , AP-HP, Hôpital Bichat-Claude Bernard , Paris , France
| | - Nidaa Mikail
- b Département de Médecine Nucléaire , AP-HP, Hôpital Bichat-Claude Bernard , Paris , France
| | - Khadija Ben Ali
- b Département de Médecine Nucléaire , AP-HP, Hôpital Bichat-Claude Bernard , Paris , France
| | - François Rouzet
- b Département de Médecine Nucléaire , AP-HP, Hôpital Bichat-Claude Bernard , Paris , France
| | - Charles Burdet
- a Service de Maladies Infectieuses et Tropicales , AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.,c INSERM, IAME, UMR 1137 , Paris , France.,d Univ Paris Diderot, Sorbonne Cité, IAME, UMR 1137 , Paris , France
| | - Yazdan Yazdanpanah
- a Service de Maladies Infectieuses et Tropicales , AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.,c INSERM, IAME, UMR 1137 , Paris , France.,d Univ Paris Diderot, Sorbonne Cité, IAME, UMR 1137 , Paris , France
| | - Veronique Joly
- a Service de Maladies Infectieuses et Tropicales , AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.,c INSERM, IAME, UMR 1137 , Paris , France.,d Univ Paris Diderot, Sorbonne Cité, IAME, UMR 1137 , Paris , France
| | - Laurent Lepage
- e Service de Chirurgie Cardiaque , AP-HP, Hôpital Bichat-Claude Bernard , Paris , France
| | - Laure Sarda-Mantel
- f Département de Médecine Nucléaire , AP-HP, Hôpital Lariboisière , Paris , France
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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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Jung JS, Lee SM, Kim HJ, Jang SH, Lee JW. A case of septic pulmonary embolism associated with renal abscess mimicking pulmonary metastases of renal malignancy. Ann Nucl Med 2014; 28:381-5. [PMID: 24481822 DOI: 10.1007/s12149-014-0811-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
We report the case of a 46-year-old woman with acute febrile symptom who had multiple pulmonary nodules and a renal mass. She underwent (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to find a hidden malignancy and the cause of her fever. FDG PET/CT images demonstrated a renal mass and multiple lung nodules with intense FDG uptake, which was suspicious of a renal malignancy with multiple pulmonary metastatic lesions. CT-guided biopsies of the pulmonary and renal lesions only showed chronic inflammatory infiltrates without evidence of malignancy. She was diagnosed with septic pulmonary embolism from a renal abscess. One month after antibiotic treatment, the follow-up chest and abdomen CT showed improvement of the lung and renal lesions. This is the first case demonstrating the FDG PET/CT finding of septic pulmonary embolism associated with renal abscess in the published literature.
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Affiliation(s)
- Jo Sung Jung
- Department of Radiology, Sooncheonhyang University Cheonan Hospital, Cheonan, Republic of Korea
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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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Abstract
Infectious endocarditis remains both a diagnostic and a treatment challenge. A positive outcome depends on a rapid diagnosis, accurate risk stratification, and a thorough follow-up. Imaging plays a key role in each of these steps and echocardiography remains the cornerstone of the methods in use. The technique of both transthoracic echocardiography and transoesophageal echocardiography has been markedly improved across the last decades and most recently three-dimensional real-time echocardiography has been introduced in the management of endocarditis patients. Echocardiography depicts structural changes and abnormalities in the heart, but it does not uncover the underlying pathophysiological processes at the cellular or molecular level. This problem is addressed with introduction of new molecular imaging methods as (18)F-fluorodesoxyglucose ((18)F-FDG) PET-CT and single photon emission computed tomography fused with conventional CT (SPECT/CT). Of these methods, (18)F-FDG PET-CT carries the best promise for a future role in endocarditis. But there are distinct limitations with both SPECT/CT and (18)F-FDG PET-CT which should not be neglected. MRI and spiral CT are methods primarily used in the search for extra cardial infectious foci. A flowchart for the use of imaging in both left-sided and right-sided endocarditis is suggested.
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Affiliation(s)
- Niels Eske Bruun
- Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup 2900, Denmark
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11
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Deep Venous Thrombosis and Pulmonary Embolism Detected by FDG PET/CT in a Patient With Bacteremia. Clin Nucl Med 2013; 38:276-7. [DOI: 10.1097/rlu.0b013e3182817aaf] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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