1
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Lv Y, Shao F, Jia Q, Lan X, Qin C. Coexistence of FDG-Avid and FDG-Negative Aneurysms in a Patient With Fever of Unknown Origin. Clin Nucl Med 2023; 48:e593-e595. [PMID: 37934712 DOI: 10.1097/rlu.0000000000004894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
ABSTRACT A 68-year-old man with intermittent fever of unknown origin for 5 months underwent 18F-FDG PET/CT to detect causative lesion. An 18F-FDG-avid lesion was revealed in the left pelvic iliac vessel region and was highly suggestive of malignancy. One and a half months later, a giant left internal iliac artery aneurysm was identified by CT angiography, corresponding to the 18F-FDG-avid lesion. Combined with elevated inflammatory markers, he was finally diagnosed as having inflammatory internal iliac artery aneurysm. An abdominal aortic aneurysm with low 18F-FDG uptake was also identified.
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Affiliation(s)
| | - Fuqiang Shao
- Department of Nuclear Medicine, The First People's Hospital of Zigong, Zigong, Sichuan, China
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2
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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.
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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.
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3
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Mikail N, Hyafil F. Turning the heart off: give it a second try? J Nucl Cardiol 2022; 29:3263-3266. [PMID: 35655114 DOI: 10.1007/s12350-022-03013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8006, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Fabien Hyafil
- Department of Nuclear Medicine, Georges-Pompidou European Hospital, DMU IMAGINA, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, 20 Rue Leblanc, 75015, Paris, France.
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4
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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.
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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
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5
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El Yaagoubi Y, Prunier-Aesch C, Chetanneau A, Philippe L, Bleuet F, Menard E, Doll G. 18F-FDG PET/CT Detection of a Popliteal Mycotic Aneurysm Complicating Staphylococcus aureus Bacteremia. Clin Nucl Med 2021; 46:411-412. [PMID: 33630810 DOI: 10.1097/rlu.0000000000003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 75-year-old man presented with Staphylococcus aureus bacteremia, fever, and right posterior knee pain. Venous Doppler ultrasound of the lower extremity showed an isolated right calf muscle vein thrombosis, without any sign of deep vein thrombosis. 18F-FDG PET/CT revealed an intense focal uptake on the right popliteal artery, suggesting a mycotic aneurysm (MA). Lower limb CT angiography confirmed an MA of the right popliteal artery. The patient underwent surgical procedure with excision of the MA, whose cultures grew methicillin-sensitive S. aureus. Our case highlights the importance of including lower limbs in 18F-FDG PET/CT acquisition in case of suspicion of septic emboli.
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Affiliation(s)
| | | | | | | | | | | | - Gérard Doll
- Cardiology, NCT+ Clinic, Saint-Cyr-Sur-Loire, France
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6
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Mikail N, Khalil A, Rouzet F. Mediastinal Masses: 18F-FDG-PET/CT Features Based on the International Thymic Malignancy Interest Group Classification. Semin Nucl Med 2020; 51:79-97. [PMID: 33246542 DOI: 10.1053/j.semnuclmed.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Imaging plays a key role in the management of mediastinal masses. In an effort to standardize the analysis of the mediastinum, the International Thymic Malignancy Interest Group (ITMIG) has proposed a three compartments-based diagnostic classification, intended for clinicians and radiologists. Several articles have documented its usefulness to guide the diagnosis using cross-sectional imaging. Similarly, fluorine-18-radiolabeled fluorodeoxyglucose positron emission tomography combined to computed tomography (18F-FDG-PET/CT) can be useful in this setting, either as a first-line diagnostic technique, or in addition to cross-sectional imaging. In this article, which is thought as an aid for nuclear medicine physicians and radiologists, we aim to present, based on the ITMIG classification, the main mediastinal pathologies that can be observed with 18F-FDG-PET/CT, and the additional diagnostic value that can be expected from this technique. For this purpose, we segmented the mediastinum according to the ITMIG classification, and reviewed the available literature for each of the corresponding organs and/or disease. Given the importance of the clinical context for the interpretation of PET imaging, we presented each of the diseases according to: (1) their suggestive clinical context; (2) the suggestive features on nonenhanced CT (which is the standard in PET imaging); and (3) the typical 18F-FDG characteristics. The purpose of this article is to depict the main features of the most common mediastinal diseases that can be encountered with 18F-FDG-PET/CT, and to highlight its diagnostic value in this setting, alone or in combination with other imaging modalities.
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Affiliation(s)
- Nidaa Mikail
- Department of nuclear medicine, Bichat universitary hospital, Paris, France.
| | - Antoine Khalil
- Department of radiology, Bichat universitary hospital, Paris, France
| | - François Rouzet
- Department of nuclear medicine, Bichat universitary hospital, Paris, France
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7
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Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
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8
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Morimoto M, Norikane T, Yamamoto Y, Mitamura K, Nishiyama Y. Early infected aneurysm with 18F-FDG uptake prior to substantial anatomical changes. J Nucl Cardiol 2019; 26:1373-1375. [PMID: 29987631 DOI: 10.1007/s12350-018-1364-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mami Morimoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa, 761-0793, Japan.
| | - Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa, 761-0793, Japan
| | - Yuka Yamamoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa, 761-0793, Japan
| | - Katsuya Mitamura
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa, 761-0793, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa, 761-0793, Japan
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9
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Erba PA, Lancellotti P, Vilacosta I, Gaemperli O, Rouzet F, Hacker M, Signore A, Slart RHJA, Habib G. Recommendations on nuclear and multimodality imaging in IE and CIED infections. Eur J Nucl Med Mol Imaging 2018; 45:1795-1815. [PMID: 29799067 DOI: 10.1007/s00259-018-4025-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 12/18/2022]
Abstract
In the latest update of the European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE), imaging is positioned at the centre of the diagnostic work-up so that an early and accurate diagnosis can be reached. Besides echocardiography, contrast-enhanced CT (ce-CT), radiolabelled leucocyte (white blood cell, WBC) SPECT/CT and [18F]FDG PET/CT are included as diagnostic tools in the diagnostic flow chart for IE. Following the clinical guidelines that provided a straightforward message on the role of multimodality imaging, we believe that it is highly relevant to produce specific recommendations on nuclear multimodality imaging in IE and cardiac implantable electronic device infections. In these procedural recommendations we therefore describe in detail the technical and practical aspects of WBC SPECT/CT and [18F]FDG PET/CT, including ce-CT acquisition protocols. We also discuss the advantages and limitations of each procedure, specific pitfalls when interpreting images, and the most important results from the literature, and also provide recommendations on the appropriate use of multimodality imaging.
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Affiliation(s)
- Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, GIGA-Cardiovascular Sciences, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Isidre Vilacosta
- Department of Cardiology, Instituto Cardiovascular, Hospital Universitario San Carlos, Madrid, Spain
| | - Oliver Gaemperli
- Interventional Cardiology and Cardiac Imaging, University Heart Center Zurich, Zurich, Switzerland
| | - Francois Rouzet
- Department of Nuclear Medicine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
- Inserm, UMR-S 1148, Paris, France
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, AKH, Vienna, Austria
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Gilbert Habib
- Aix-Marseille University, URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095- IHU - Méditerranée Infection, Marseille, France
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
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10
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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.
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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.
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11
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18F-FDG-PET/CT Imaging to Diagnose Septic Emboli and Mycotic Aneurysms in Patients with Endocarditis and Cardiac Device Infections. Curr Cardiol Rep 2018; 20:14. [PMID: 29511975 DOI: 10.1007/s11886-018-0956-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW This review analyzes recent studies evaluating the diagnostic value of 18F-FDG-PET/CT for the detection of peripheral emboli and secondary infectious foci in patients with infective endocarditis and cardiac device infections. RECENT FINDINGS Detection of extracardiac septic localizations in patients with infective endocarditis and cardiac device infections is crucial, as it may impact the diagnosis, prognosis, and therapeutic management. Recent literature substantiated the clinical usefulness of 18F-FDG-PET/CT in this setting. 18F-FDG-PET/CT has proven its high diagnostic value for the detection of peripheral emboli in patients with infective endocarditis and cardiac device infections, substantially affecting patients' outcome and treatment. A multimodal approach, combining the high sensitivity of 18F-FDG-PET/CT with morphological imaging seems promising.
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12
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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
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13
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Additional Diagnostic Value of Combined Angio-Computed Tomography and 18F-Fluorodeoxyglucose Positron Emission Tomography in Infectious Aortitis. JACC Cardiovasc Imaging 2017; 11:361-364. [PMID: 29055634 DOI: 10.1016/j.jcmg.2017.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/21/2022]
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14
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Pet Scan and Duplex Ultrasound for the Detection of Arterial Complications of Bacterial Endocarditis. Ann Vasc Surg 2017; 44:423.e1-423.e2. [DOI: 10.1016/j.avsg.2017.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 11/20/2022]
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15
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Multilevel Mycotic Aneurysms Due to Salmonella Infection: Case Report and Review of the Literature. Ann Vasc Surg 2017; 44:424.e11-424.e13. [PMID: 28602900 DOI: 10.1016/j.avsg.2017.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/18/2017] [Indexed: 01/16/2023]
Abstract
Infected or mycotic aneurysms (MAs) of the aorta and adjacent arteries are rare and difficult to treat. We report a unique case of a Salmonella serotype enteritidis-induced rapidly expanding aortic and iliac pseudoaneurysm during preoperative workup. Based on the presented case, we postulate that the agressive nature of Salmonella enteritidis MAs should not be underestimated. If postponed intervention is chosen and the patient is managed conservatively with antibiotic therapy to create a window of definitive diagnosis, one should consider close follow-up imaging to observe progression of the pseudoaneurysm. This may prevent the need of acute intervention.
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16
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Chetouani A, Perrin M, Drouet C, Marie PY, Verger A. Aneurysmal angiosarcoma associated with vascular graft revealed by 18F-FDG-PET imaging. Radiol Case Rep 2017; 12:413-415. [PMID: 28491200 PMCID: PMC5417621 DOI: 10.1016/j.radcr.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 11/30/2022] Open
Abstract
We report a rare case of vascular graft-associated aneurysmal angiosarcoma by 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET). An 81-year-old male patient, with a prior history of graft interposition 1 year previously, was referred to 18F-FDG-PET because of an inflammatory syndrome of unknown origin. FDG-PET images revealed a particular pattern of intense circular uptake within the arterial wall (SUVmax = 10) in a popliteal aneurysm and, additionally, a large hypermetabolic mass centered by the graft. Remote hypermetabolisms in lung nodules and pleural thickenings were also detected. The diagnosis of angiosarcoma was ascertained through histopathological analysis of surgical samples. Development of an aneurysmal angiosarcoma at the site of a vascular graft is a rare entity, often misdiagnosed. 18F-FDG-PET appears to be useful in its detection with a PET pattern of intense circular uptake within the arterial wall. Such finding should lead to the search for distant metastasis.
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Affiliation(s)
- Ahmed Chetouani
- Department of Nuclear Medicine, CHRU-Nancy, rue du Morvan, Nancy F-54000, France
| | - Mathieu Perrin
- Department of Nuclear Medicine, CHRU-Nancy, rue du Morvan, Nancy F-54000, France
| | - Clément Drouet
- Department of Nuclear Medicine, CHRU-Besançon, Besançon F-25000, France
| | - Pierre-Yves Marie
- Department of Nuclear Medicine, CHRU-Nancy, rue du Morvan, Nancy F-54000, France.,Nancyclotep Platform Imaging, rue du Morvan, Nancy F-54000, France
| | - Antoine Verger
- Department of Nuclear Medicine, CHRU-Nancy, rue du Morvan, Nancy F-54000, France.,Nancyclotep Platform Imaging, rue du Morvan, Nancy F-54000, France
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Characterization of
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F-Fluorodeoxyglucose Uptake Pattern in Noninfected Prosthetic Heart Valves. Circ Cardiovasc Imaging 2017; 10:e005585. [DOI: 10.1161/circimaging.116.005585] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 01/12/2017] [Indexed: 01/22/2023]
Abstract
Background—
18
F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been recently acknowledged as a diagnostic tool for prosthetic valve endocarditis, but its specificity is limited by uptake on noninfected valves. The objective of this study was to outline the main features of FDG uptake on PET/CT in patients with noninfected prosthetic heart valve (PHV).
Methods and Results—
Our institution’s PET/CT database was reviewed to identify patients with PHV, excluding those suspected of infection or who had received antibiotic treatment. PET indication, valve location, and type (biological/mechanical) and time from implantation were collected for each patient. Images with and without attenuation correction were considered for interpretation. The pattern of FDG uptake (absent, homogeneous, or heterogeneous) was recorded. Fifty-four PHVs (51 patients) were identified, including 32 biological valves. Indications for PET were oncology (n=26), suspicion of prosthetic valve endocarditis subsequently excluded (n=17), and history of vasculitis (n=11). A periprosthetic FDG uptake was present in 47 (87%) and 30 (56%) PHVs with and without attenuation correction, respectively, and the pattern was homogeneous in all but 4 (7%) and 3 (6%) PHVs, respectively. On quantitative analysis, maximum standardized uptake values was greater in mechanical than in biological valves (4.0 [2.4–8.0] versus 3.3 [2.1–6.1];
P
=0.01) and in patients with vasculitis than in those referred for other indications. The uptake intensity did not differ before and 3 months after valve replacement.
Conclusions—
Noninfected PHVs frequently display homogeneous FDG uptake, which remains steady over time. Caution is, therefore, needed when interpreting FDG PET/CT in suspected prosthetic valve endocarditis, with specific attention to uptake pattern.
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19
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Hyafil F, Rouzet F, Le Guludec D. Nuclear imaging for patients with a suspicion of infective endocarditis: Be part of the team! J Nucl Cardiol 2017; 24:207-211. [PMID: 26715601 DOI: 10.1007/s12350-015-0369-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
The diagnosis of infective endocarditis (IE) is challenging and requires the association of morphological features suggestive of valvular infection such as the presence of vegetations or abscesses identified usually with echocardiography and positive blood culture or serologies suggestive of systemic bacterial infection. In the past 5 years, several groups confirmed the incremental value of FDG-PET imaging and radiolabeled leukocyte scintigraphy over echocardiography for the diagnosis of IE. Based on the latter studies, the presence of abnormal activity in the perivalvular region on either FDG-PET imaging or radiolabeled leukocyte scintigraphy has been added as a major criterion for the diagnosis of IE in the guidelines recently published. Nuclear physicians should therefore learn not only the imaging criteria in favor of active IE but also the pitfalls of these nuclear imaging techniques in order to give a useful answer to the referring physician for the management of these patients. In fact, the diagnosis of IE is often complex and requires the integration of multiple clinical, biological, and imaging parameters. Multi-disciplinary teams including cardiologists, infectious disease physicians, cardiac surgeons, and radiologists have been therefore set up in several institutions to discuss the diagnosis and management of patients with a suspicion of IE. It is now time for nuclear cardiologists to join the team.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bichat, Département Hospitalo-Universitaire FIRE, Inserm 1148, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France.
| | - François Rouzet
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bichat, Département Hospitalo-Universitaire FIRE, Inserm 1148, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bichat, Département Hospitalo-Universitaire FIRE, Inserm 1148, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France
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