1
|
Nakahara T, Fujimoto S, Jinzaki M. Molecular imaging of cardiovascular disease: Current status and future perspective. J Cardiol 2025; 85:386-398. [PMID: 39922562 DOI: 10.1016/j.jjcc.2025.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 01/15/2025] [Accepted: 01/28/2025] [Indexed: 02/10/2025]
Abstract
Advancements in knowledge of cardiovascular disease, pharmacology, and chemistry have led to the development of newer radiopharmaceuticals and targets for new and more suitable molecules. Molecular imaging encompasses multiple imaging techniques for identifying the characteristics of key components involved in disease. Despite its limitations in spatial resolution, the affinity for key molecules compensates for disadvantages in diagnosing diseases and elucidating their pathophysiology. This review introduce established molecular tracers involved in clinical practice and emerging tracers already applied in clinical studies, classifying the key component in A: artery, specifically those vulnerable plaque (A-I) inflammatory cells [18F-FDG]; A-II) lipid/fatty acid; A-III) hypoxia; A-IV) angiogenesis; A-V) protease [18F/68Ga-FAPI]; A-VI) thrombus/hemorrhage; A-VII) apoptosis and A-VIII) microcalcification [18F-NaF]) and B: myocardium, including myocardial ischemia, infarction and myocardiopathy (B-I) myocardial ischemia; B-II) myocardial infarction (myocardial damage and fibrosis); B-III) myocarditis and endocarditis; B-IV) sarcoidosis; B-V) amyloidosis; B-VI) metabolism; B-VII) innervation imaging). In addition to cardiovascular-specific tracers tested in animal models, many radiotracers may have been developed in other areas, such as oncology imaging or neuroimaging. While this review does not cover all available tracers, some of them hold potential for future use assessing cardiovascular disease. Advances in molecular biology, pharmaceuticals, and imaging sciences will facilitate the identification of precise disease mechanisms, enabling precise diagnoses, better assessment of disease status, and enhanced therapeutic evaluation in this multi-modality era.
Collapse
Affiliation(s)
- Takehiro Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Schulte J, Maurer A, Domogalla LC, Steinacker N, Wadle C, Kinzler J, Eder M, von zur Mühlen C, Krohn-Grimberghe M, Eder AC. 2-[18F]F-p-Aminobenzoic Acid Specifically Detects Infective Endocarditis in Positron Emission Tomography. J Infect Dis 2025; 231:e536-e544. [PMID: 39514763 PMCID: PMC11911914 DOI: 10.1093/infdis/jiae547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 10/31/2024] [Accepted: 11/07/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a life-threatening disease with high mortality, particularly when caused by Staphylococcus aureus (S aureus). Traditional diagnosis relies on clinical assessment, blood cultures, and imaging (eg, echocardiography) but lacks methods for direct bacterial detection on the endothelium. Positron emission tomography (PET)/computed tomography is emerging as valuable in unclear IE cases. This study evaluates 2-[18F]F-p-aminobenzoic acid (2-[18F]F-PABA), a bacteria-specific PET tracer, for detecting IE. METHODS In vitro assays measured 2-[18F]F-PABA uptake by S aureus, distinguishing living bacteria from dead cells. A mouse model of IE provided proof-of-concept PET/magnetic resonance imaging (MRI) data for diagnosing IE. Additionally, a subcutaneous abscess model with larger bacterial vegetations was used to enhance imaging of bacterial uptake. RESULTS 2-[18F]F-PABA uptake by S aureus was confirmed in vitro, with accumulation limited to living bacteria and varying across strains. In vivo, 2-[18F]F-PABA PET/MRI successfully visualized IE in mice. In the subcutaneous abscess model, the tracer effectively localized S aureus vegetations, emphasizing its potential in detecting bacterial foci. CONCLUSIONS This study highlights the potential of 2-[18F]F-PABA PET imaging for direct visualization of IE. Future research may further investigate its diagnostic performance in larger models, aiming toward clinical application as a precise, pathogen-specific imaging tool for managing IE.
Collapse
Affiliation(s)
- Johannes Schulte
- University Heart Center Freiburg–Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Maurer
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, Eberhard Karls University, Tuebingen, Germany
- German Cancer Consortium and German Cancer Research Center, partner site Tuebingen, Germany
| | - Lisa-Charlotte Domogalla
- Department of Nuclear Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium, partner site Freiburg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Nils Steinacker
- Department of Nuclear Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium, partner site Freiburg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Carolin Wadle
- University Heart Center Freiburg–Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Kinzler
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University, Tuebingen, Germany
| | - Matthias Eder
- Department of Nuclear Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium, partner site Freiburg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Constantin von zur Mühlen
- University Heart Center Freiburg–Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marvin Krohn-Grimberghe
- University Heart Center Freiburg–Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology, Ulm University Heart Center, University of Ulm, Ulm, Germany
| | - Ann-Christin Eder
- Department of Nuclear Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Radiopharmaceutical Development, German Cancer Consortium, partner site Freiburg, Germany
- German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
3
|
Daniel E, El-Nayir M, Ezeani C, Nwaezeapu K, Ogedegbe OJ, Khan M. The role of multimodal imaging in the diagnosis of prosthetic valve and intracardiac device endocarditis: A review. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2025; 41:409-417. [PMID: 39585526 DOI: 10.1007/s10554-024-03277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 10/27/2024] [Indexed: 11/26/2024]
Abstract
Infective endocarditis (IE) is a severe cardiac condition associated with substantial morbidity and mortality. Traditionally, the modified Duke's criteria have been used to establish the diagnosis of IE, which includes using transthoracic and transesophageal echocardiography. While echocardiography performs well in diagnosing native valve endocarditis, its diagnostic accuracy decreases in patients with prosthetic valves or implanted cardiac devices such as pacemakers and defibrillators. Given these limitations and advancements in cardiac imaging, including multimodal computed tomography, magnetic resonance imaging, and positron emission tomography, there has been growing interest in the utility of these techniques for diagnosing prosthetic valve endocarditis (PVE) and Cardiovascular implantable electronic device infection (CIEDI). Although numerous studies have investigated the value of these imaging modalities, their findings have been inconsistent. This article aims to reevaluate the role of advanced imaging in diagnosing PVE and CIEDI and its impact on managing prosthetic valves and device-related infective endocarditis. Methods A comprehensive literature search was conducted in PubMed, Cochrane library, Google Scholar, Embase, and other relevant databases. Key terms such as 'infective endocarditis,' 'multimodal imaging,' 'prosthetic valve endocarditis,' '18F-FDG PET,' 'cardiac MRI,' and 'cardiac CT' were used to identify studies that investigated the role of these imaging modalities in diagnosing PVE and CIEDI. Publications with full text including randomized controlled trials, retrospective studies, case reports, case series, reviews of literature, and society guidelines were included.
Collapse
Affiliation(s)
| | | | | | | | | | - Misha Khan
- Trinity Health Ann Arbor, Ypsilanti, MI, USA
| |
Collapse
|
4
|
Vinod P, Khayata M, Haouzi A, Xu B. Role of multimodality imaging in infective endocarditis: A comparison of the major society guidelines in the United States and Europe. Trends Cardiovasc Med 2025; 35:10-21. [PMID: 38677351 DOI: 10.1016/j.tcm.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
Infective endocarditis (IE) is a life-threatening condition, and early diagnosis and management are critical. There is emerging evidence on the role of advanced imaging modalities including dedicated cardiac computed tomography (CCT), and 18F-fluorodeoxyglucose positron emission tomography (PET). The updated 2023 European Society of Cardiology (ESC) guidelines have emphasized increased utilization of multimodality imaging in the diagnosis and management of IE. In this review, we elaborate on recent recommendations from the updated 2023 ESC guidelines, with comparisons to the current American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, focusing on multimodality imaging in IE.
Collapse
Affiliation(s)
- Poornima Vinod
- UNC Health at Southeastern, Department of Internal Medicine, Lumberton, NC 28358, USA
| | - Mohamed Khayata
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Alice Haouzi
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
| |
Collapse
|
5
|
Holcman K, Ząbek A, Boczar K, Rubiś P, Ćmiel B, Szot W, Stępień A, Graczyk K, Podolec P, Kostkiewicz M. The [ 99mTc]Tc-HMPAO-labelled white blood cell SPECT/CT as a novel criterion for infective endocarditis diagnosis. Int J Cardiol 2024; 417:132545. [PMID: 39265788 DOI: 10.1016/j.ijcard.2024.132545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 08/11/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
AIMS Infective endocarditis (IE) poses a significant clinical challenge, necessitating nuanced diagnostic tools for early and accurate detection. The diagnostic role of the hybrid technique of single-photon emission tomography-computed tomography with technetium-99 m-hexamethylpropyleneamine oxime-labelled leukocytes ([99mTc]Tc-HMPAO-SPECT/CT) has evolved in recent years. This single-center study assessed whether the recent inclusion in the 2023 European Society of Cardiology modified diagnostic criteria of IE (2023 ESC) of infectious lesions detected with [99mTc]Tc-HMPAO-SPECT/CT affects their diagnostic performance. METHODS AND RESULTS Between 2015 and 2019, we enrolled 205 consecutive adults with suspected IE. All participants underwent [99mTc]Tc-HMPAO-SPECT/CT scans (370-740 MBq). Scans were deemed positive in the presence of intracardiac abnormal tracer uptake and/or within the cardiac implantable electronic device. Patients were prospectively followed-up for 12 ± 10 months. Local device infection (LDI) or IE was diagnosed in 75 (36.6 %) patients, while 72 (35.1 %) [99mTc]Tc-HMPAO-SPECT/CT results returned positive. Moreover, extracardiac infectious foci were detected in 25 % of [99mTc]Tc-HMPAO-SPECT/CT scans. The inclusion of both intracardiac and extracardiac lesions detected with [99mTc]Tc-HMPAO-SPECT/CT yields significantly higher sensitivity (p = 0.003) and negative predictive value (NPV) (p = 0.009). CONCLUSION The inclusion of [99mTc]Tc-HMPAO-SPECT/CT into the IE diagnostic work-up improves the appropriate classification of patients. For patients with IE, the extended inclusion of lesions detected with [99mTc]Tc-HMPAO-SPECT/CT in the ESC 2023 diagnostic criteria significantly improves sensitivity and NPV while reducing potential IE misdiagnoses. This pioneering imaging modality is poised to become an integral component of clinical practice, promising to advance IE diagnosis and management.
Collapse
Affiliation(s)
- Katarzyna Holcman
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland.
| | - Andrzej Ząbek
- Jagiellonian University Medical College, Department of Electrocardiology, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Boczar
- Jagiellonian University Medical College, Department of Electrocardiology, John Paul II Hospital, Krakow, Poland
| | - Paweł Rubiś
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Bogdan Ćmiel
- AGH University of Science and Technology, Faculty of Applied Mathematics, Krakow, Poland
| | - Wojciech Szot
- John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland; Jagiellonian University Medical College, Department of Hygiene and Dietetics, Krakow, Poland
| | - Agnieszka Stępień
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Katarzyna Graczyk
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Magdalena Kostkiewicz
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland
| |
Collapse
|
6
|
Hatab T, Zaid S, Thakkar SJ, Bou Chaaya RG, Goel SS, Reardon MJ. Infection of Transcatheter Valvular Devices. Curr Cardiol Rep 2024; 26:767-775. [PMID: 38806975 DOI: 10.1007/s11886-024-02076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW This review explores the epidemiology, clinical traits, and diagnosis of Transcatheter Aortic Valve Replacement-Associated Infective Endocarditis (TAVR-IE) and mitral transcatheter edge-to-edge repair infective endocarditis (TEER-IE), focusing on a multimodal imaging approach. It addresses the rising prevalence of TAVR and TEER, emphasizing the need to understand long-term complications and clinical consequences, which poses significant challenges despite advancements in valve technology. RECENT FINDINGS Studies report a variable incidence of TAVR-IE and TEER-IE influenced by diverse patient risk profiles and procedural factors. Younger age, male gender, and certain comorbidities emerge as patient-related risk factors. Procedure-related factors include intervention location, valve type, and technical aspects. Microbiologically, Staphylococcus aureus, Viridans Group Streptococcus, and Enterococcus are frequently encountered pathogens. TAVR-IE and TEER-IE diagnosis involves a multimodal imaging approach due to limitations in echocardiography. Blood cultures and imaging aid identification, with Fluorescence in situ hybridization is showing promise. Treatment encompasses medical management with antibiotics and, when necessary, surgical intervention. The management approach requires a multidisciplinary "Endocarditis Team." This review underscores the need for continued research to refine risk prediction, enhance diagnostic accuracy, and optimize management strategies for TAVR-IE, considering the evolving landscape of transcatheter interventions.
Collapse
Affiliation(s)
- Taha Hatab
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Syed Zaid
- Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, TX, USA
| | - Samarthkumar J Thakkar
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Rody G Bou Chaaya
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Michael J Reardon
- Division of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA.
| |
Collapse
|
7
|
Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and Radiolabeled Leukocyte SPECT/CT Imaging for the Evaluation of Cardiovascular Infection in the Multimodality Context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations From ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. JACC Cardiovasc Imaging 2024; 17:669-701. [PMID: 38466252 DOI: 10.1016/j.jcmg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multisocietal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multifocal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
Collapse
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Heart Rhythm 2024; 21:e1-e29. [PMID: 38466251 DOI: 10.1016/j.hrthm.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
Collapse
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Moreira GS, Feijóo NDAP, Tinoco-da-Silva IB, Aguiar CM, da Conceição FO, de Castro GCM, de Carvalho MGB, de Almeida TVDPA, Garrido RQ, Lamas CDC. Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses. Trop Med Infect Dis 2024; 9:83. [PMID: 38668544 PMCID: PMC11053958 DOI: 10.3390/tropicalmed9040083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
Infective endocarditis (IE) is characterised by fever, heart murmurs, and emboli. Splenic emboli are frequent in left-sided IE. A systematic review of the literature published on splenic embolism (SE) between 2000 and 2023 was conducted. Search strategies in electronic databases identified 2751 studies published between 1 January 2000 and 4 October 2023, of which 29 were finally included. The results showed that the imaging tests predominantly used to detect embolisms were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)/CT, single-photon emission computed tomography/CT, ultrasound, and contrast-enhanced ultrasound. More recent studies typically used 18F-FDG PET-CT. The proportion of SE ranged from 1.4% to 71.7%. Only seven studies performed systematic conventional CT screening for intra-abdominal emboli, and the weighted mean frequency of SE was 22% (range: 8-34.8%). 18F-FDG PET-CT was performed systematically in seven studies, and splenic uptake was found in a weighted mean of 4.5%. There was a lack of uniformity in the published literature regarding the frequency and management of splenic embolisation. CT scans were the most frequently used method, until recently, when 18F-FDG PET-CT scans began to predominate. More data are necessary regarding the frequency of SE, especially focusing on their impact on IE management and prognosis.
Collapse
Affiliation(s)
- Gabriel Santiago Moreira
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
| | - Nícolas de Albuquerque Pereira Feijóo
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Isabella Braga Tinoco-da-Silva
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
| | - Cyntia Mendes Aguiar
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | | | - Gustavo Campos Monteiro de Castro
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Mariana Giorgi Barroso de Carvalho
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Thatyane Veloso de Paula Amaral de Almeida
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Rafael Quaresma Garrido
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-360, Rio de Janeiro, Brazil
| | - Cristiane da Cruz Lamas
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-360, Rio de Janeiro, Brazil
| |
Collapse
|
10
|
Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. J Nucl Cardiol 2024; 34:101786. [PMID: 38472038 DOI: 10.1016/j.nuclcard.2023.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
Collapse
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Clin Infect Dis 2024:ciae046. [PMID: 38466039 DOI: 10.1093/cid/ciae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
Collapse
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
12
|
Dalebout EM, Hirsch A, Kluin J, Galema TW, Roos-Hesselink JW, Budde RP. Computed Tomography in Infectious Endocarditis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101292. [PMID: 39131217 PMCID: PMC11308100 DOI: 10.1016/j.jscai.2023.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 08/13/2024]
Abstract
Imaging is one of the cornerstones in diagnosis and management of infective endocarditis, underlined by recent guidelines. Echocardiography is the first-line imaging technique, however, computed tomography (CT) has a class I recommendation in native and prosthetic valve endocarditis to detect valvular lesions in case of possible endocarditis and to detect paravalvular and periprosthetic complications in case of inconclusive echocardiography. Echocardiography has a higher diagnostic accuracy than CT in detecting valvular lesions, but not for diagnosing paravalvular lesions where CT is superior. Additionally, CT is useful and recommended by guidelines to detect extracardiac manifestations of endocarditis and in planning surgical treatment including assessment of the coronary arteries. The advent of photon-counting CT and its improved spatial resolution and spectral imaging is expected to expand the role of CT in the diagnosis of infective endocarditis. In this review, we provide an overview of the current role of CT in infective endocarditis focusing on image acquisition, image reconstruction, interpretation, and diagnostic accuracy.
Collapse
Affiliation(s)
- Eefje M. Dalebout
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
| | - Tjebbe W. Galema
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
| | - Ricardo P.J. Budde
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| |
Collapse
|
13
|
Burban A, Słupik D, Reda A, Szczerba E, Grabowski M, Kołodzińska A. Novel Diagnostic Methods for Infective Endocarditis. Int J Mol Sci 2024; 25:1245. [PMID: 38279244 PMCID: PMC10816594 DOI: 10.3390/ijms25021245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Infective endocarditis (IE) remains a dangerous disease and continues to have a high mortality rate. Unfortunately, despite continuous improvements in diagnostic methods, in many cases, blood cultures remain negative, and the pathogen causing endocarditis is unknown. This makes targeted therapy and the selection of appropriate antibiotics impossible. Therefore, we present what methods can be used to identify the pathogen in infective endocarditis. These are mainly molecular methods, including PCR and MGS, as well as imaging methods using radiotracers, which offer more possibilities for diagnosing IE. However, they are still not widely used in the diagnosis of IE. The article summarizes in which cases we should choose them and what we are most hopeful about in further research into the diagnosis of IE. In addition, registered clinical trials that are currently underway for the diagnosis of IE are also presented.
Collapse
Affiliation(s)
- Anna Burban
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dorota Słupik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Reda
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Ewa Szczerba
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Agnieszka Kołodzińska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| |
Collapse
|
14
|
Khayata M, Sanchez Nadales A, Xu B. Contemporary applications of multimodality imaging in infective endocarditis. Expert Rev Cardiovasc Ther 2024; 22:27-39. [PMID: 37996246 DOI: 10.1080/14779072.2023.2288152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/22/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Infective endocarditis (IE) is an increasingly important condition with significant morbidity and mortality. With advancements in cardiovascular interventions including prosthetic valve implantation and utilization of intracardiac devices, the prevalence of IE is rising in the modern era. Early detection and management of this condition are critical. AREAS COVERED This review presents a contemporary review of the applications of multi-modality imaging in IE, taking a comparative approach of the various imaging modalities. EXPERT OPINION Transthoracic and transesophageal echocardiography are essential imaging modalities in establishing the diagnosis of IE, as well as evaluating for complications of IE. Other imaging modalities such as cardiac computed tomography and nuclear imaging play an important role as adjuvant imaging modalities for the evaluation of IE, particularly in prosthetic valve IE and cardiovascular implantable device associated IE. It is crucial to understand the strengths, weaknesses, and clinical application of each imaging modality, to improve the diagnosis, management, and outcomes of patients with IE.
Collapse
Affiliation(s)
- Mohamed Khayata
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | | | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland, OH, USA
| |
Collapse
|
15
|
Haouzi A, Khayata M, Xu B. Relevance of cardiac imaging in the evolving landscape of infective endocarditis management. Ther Adv Cardiovasc Dis 2024; 18:17539447241305587. [PMID: 39655905 PMCID: PMC11632876 DOI: 10.1177/17539447241305587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 11/19/2024] [Indexed: 12/13/2024] Open
Abstract
Infective endocarditis (IE) is an increasingly recognized condition with high morbidity. Patients with atypical symptoms, culture-negative infections, and prosthetic cardiac devices and implants represent challenging populations to evaluate and manage. Recent major society guidelines have recommended the appropriate incorporation of multimodality imaging in the evaluation of these more complex IE cases. This article draws on the available literature regarding the different cardiac imaging modalities and discusses the role of multimodality imaging in IE.
Collapse
Affiliation(s)
- Alice Haouzi
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mohamed Khayata
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| |
Collapse
|
16
|
Thong EHE, Kong WKF, Poh KK, Wong R, Chai P, Sia CH. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. J Cardiovasc Dev Dis 2023; 11:13. [PMID: 38248883 PMCID: PMC10816708 DOI: 10.3390/jcdd11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.
Collapse
Affiliation(s)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| |
Collapse
|
17
|
Babes EE, Bustea C, Ilias TI, Babes VV, Luca SA, Luca CT, Radu AF, Tarce AG, Bungau AF, Bustea C. Multimodality Imaging Diagnosis in Infective Endocarditis. Life (Basel) 2023; 14:54. [PMID: 38255669 PMCID: PMC10821102 DOI: 10.3390/life14010054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Imaging is an important tool in the diagnosis and management of infective endocarditis (IE). Echocardiography is an essential examination, especially in native valve endocarditis (NVE), but its diagnostic accuracy is reduced in prosthetic valve endocarditis (PVE). The diagnostic ability is superior for transoesophageal echocardiography (TEE), but a negative test cannot exclude PVE. Both transthoracic echocardiography (TTE) and TEE can provide normal or inconclusive findings in up to 30% of cases, especially in patients with prosthetic devices. New advanced non-invasive imaging tests are increasingly used in the diagnosis of IE. Nuclear medicine imaging techniques have demonstrated their superiority over TEE for the diagnosis of PVE and cardiac implantable electronic device infective endocarditis (CIED-IE). Cardiac computed tomography angiography imaging is useful in PVE cases with inconclusive TTE and TEE investigations and for the evaluation of paravalvular complications. In the present review, imaging tools are described with their values and limitations for improving diagnosis in NVE, PVE and CIED-IE. Current knowledge about multimodality imaging approaches in IE and imaging methods to assess the local and distant complications of IE is also reviewed. Furthermore, a potential diagnostic work-up for different clinical scenarios is described. However, further studies are essential for refining diagnostic and management approaches in infective endocarditis, addressing limitations and optimizing advanced imaging techniques across different clinical scenarios.
Collapse
Affiliation(s)
- Elena Emilia Babes
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Tiberia Ioana Ilias
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Victor Vlad Babes
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Silvia-Ana Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Constantin Tudor Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Andrei-Flavius Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Alexandra Georgiana Tarce
- Medicine Program of Study, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Alexa Florina Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Cristian Bustea
- Department of Surgery, Oradea County Emergency Clinical Hospital, 410169 Oradea, Romania;
| |
Collapse
|
18
|
Grambow-Velilla J, Mahida B, Benali K, Deconinck L, Chong-Nguyen C, Cimadevilla C, Duval X, Iung B, Rouzet F, Hyafil F. Prognosis and follow-up of patients with prosthetic valve endocarditis treated conservatively in relation to WBC-SPECT imaging. J Nucl Cardiol 2023; 30:2633-2643. [PMID: 37430176 DOI: 10.1007/s12350-023-03335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Our objective was to evaluate in patients with prosthetic valve endocarditis (PVE) treated conservatively, the prognostic value of white blood cell (WBC) signal intensity on SPECT and to describe the evolution of the WBC signal under antibiotics. METHODS Patients with PVE treated conservatively and positive WBC-SPECT imaging were identified retrospectively. Signal intensity was classified as intense if equal to or higher, or mild if lower, than the liver signal. Clinical, biological, imaging and follow-up information were collected from medical files. RESULTS Among 47 patients, WBC signal was classified as intense in 10 patients and as mild, in 37. The incidence of the primary composite endpoint (death, late cardiac surgery, or relapse) was significantly higher in patients with intense vs. mild signal (90% vs. 11%). Twenty-five patients underwent a second WBC-SPECT imaging during follow-up. The prevalence of WBC signal decreased progressively from 89% between 3 and 6 weeks to 42% between 6 and 9 weeks and 8% more than 9 weeks after initiation of antibiotics. CONCLUSIONS In patients with PVE treated conservatively, intense WBC signal was associated with poor outcome. WBC-SPECT imaging appears as an interesting tool for risk stratification and to monitor locally the efficacy of antibiotic treatment.
Collapse
Affiliation(s)
- Julia Grambow-Velilla
- Department of Nuclear Medicine, AP-HP, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France
- INSERM U970, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France
| | - Besma Mahida
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Khadija Benali
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Laurene Deconinck
- Department of Infectious Diseases, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Caroline Chong-Nguyen
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Claire Cimadevilla
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Department of Cardiac Surgery, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Xavier Duval
- Department of Infectious Diseases, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Department of Cardiac Surgery, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Center for Clinical Investigation, AP-HP, Bichat University Hospital, University of Paris-CIté, 75018, Paris, France
| | - Bernard Iung
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - François Rouzet
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Fabien Hyafil
- Department of Nuclear Medicine, AP-HP, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France.
- INSERM U970, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France.
| |
Collapse
|
19
|
Kahts M, Guo H, Kommidi H, Yang Y, Sayman HB, Summers B, Ting R, Zeevaart JR, Sathekge M, Aras O. 89Zr-leukocyte labelling for cell trafficking: in vitro and preclinical investigations. EJNMMI Radiopharm Chem 2023; 8:36. [PMID: 37930454 PMCID: PMC10628102 DOI: 10.1186/s41181-023-00223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The non-invasive imaging of leukocyte trafficking to assess inflammatory areas and monitor immunotherapy is currently generating great interest. There is a need to develop more robust cell labelling and imaging approaches to track living cells. Positron emission tomography (PET), a highly sensitive molecular imaging technique, allows precise signals to be produced from radiolabelled moieties. Here, we developed a novel leukocyte labelling approach with the PET radioisotope zirconium-89 (89Zr, half-life of 78.4 h). Experiments were carried out using human leukocytes, freshly isolated from whole human blood. RESULTS The 89Zr-leukocyte labelling efficiency ranged from 46 to 87% after 30-60 min. Radioactivity concentrations of labelled cells were up to 0.28 MBq/1 million cells. Systemically administered 89Zr-labelled leukocytes produced high-contrast murine PET images at 1 h-5 days post injection. Murine biodistribution data showed that cells primarily distributed to the lung, liver, and spleen at 1 h post injection, and are then gradually trafficked to liver and spleen over 5 days. Histological analysis demonstrated that exogenously 89Zr-labelled human leukocytes were present in the lung, liver, and spleen at 1 h post injection. However, intravenously injected free [89Zr]Zr4+ ion showed retention only in the bone with no radioactivity in the lung at 5 days post injection, which implied good stability of radiolabelled leukocytes in vivo. CONCLUSIONS Our study presents a stable and generic radiolabelling technique to track leukocytes with PET imaging and shows great potential for further applications in inflammatory cell and other types of cell trafficking studies.
Collapse
Affiliation(s)
- Maryke Kahts
- Pharmaceutical Sciences Department, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, South Africa.
| | - Hua Guo
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medicine, New York, NY, 10065, USA
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Harikrishna Kommidi
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medicine, New York, NY, 10065, USA
| | - Yanping Yang
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medicine, New York, NY, 10065, USA
| | - Haluk Burcak Sayman
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, 34303, Fatih, Istanbul, Turkey
| | - Beverley Summers
- Pharmaceutical Sciences Department, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, South Africa
| | - Richard Ting
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medicine, New York, NY, 10065, USA
| | - Jan Rijn Zeevaart
- Radiochemistry, The South African Nuclear Energy Corporation, Pelindaba, Hartebeespoort, 0240, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
- DST/NWU, Preclinical Drug Development Platform, North West University, Potchefstroom, 2520, South Africa
| | - Mike Sathekge
- Nuclear Medicine Research Infrastructure (NuMeRI), Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Omer Aras
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| |
Collapse
|
20
|
Roll W, Faust A, Hermann S, Schäfers M. Infection Imaging: Focus on New Tracers? J Nucl Med 2023; 64:59S-67S. [PMID: 37918846 DOI: 10.2967/jnumed.122.264869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/31/2023] [Indexed: 11/04/2023] Open
Abstract
Infections account for relevant morbidity and mortality, especially if the cardiovascular system is affected. Clinical manifestations are often unspecific, resulting in a challenging diagnostic work-up. The use of molecular imaging methods, namely [18F]FDG PET and leukocyte scintigraphy, is increasingly recognized in recently published international guidelines. However, these 2 established methods focus on the host's immune response to the pathogen and are therefore virtually unable to differentiate infection from inflammation. Targeting the microorganism responsible for the infection directly with novel imaging agents is a promising strategy to overcome these limitations. In this review, we discuss clinically approved [18F]FDG PET with its advantages and limitations in cardiovascular infections, followed by new PET-based approaches for the detection of cardiovascular infections by bacteria-specific molecular imaging methods. A multitude of different targeting options has already been preclinically evaluated, but most still lack clinical translation. We give an overview not only on promising tracer candidates for noninvasive molecular imaging of infections but also on issues hampering clinical translation.
Collapse
Affiliation(s)
- Wolfgang Roll
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; and
| | - Andreas Faust
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; and
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Sven Hermann
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; and
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| |
Collapse
|
21
|
Jamil Y, Akinleye A, Mirzaei M, Lempel M, Farhat K, Pan S. Candida endocarditis: Update on management considerations. World J Cardiol 2023; 15:469-478. [PMID: 37900901 PMCID: PMC10600790 DOI: 10.4330/wjc.v15.i10.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 10/24/2023] Open
Abstract
The rise in incidence rates of invasive candidiasis warrants an increase in attention and efforts toward preventing and treating this virulent infection. Cardiac involvement is one of the most feared sequelae and has a poor prognosis. Despite the introduction of several novel antifungal agents over the past quarter century, complications and mortality rates due to Candida endocarditis have remained high. Although fungal endocarditis has a mechanism similar to bacterial endocarditis, no specific diagnostic criteria or algorithm exists to help guide its management. Furthermore, recent data has questioned the current guidelines recommending a combined approach of antifungal agents with surgical valve or indwelling prostheses removal. With the emergence of multidrug-resistant Candida auris, a focus on improved prophylactic measures and management strategies is necessary.
Collapse
Affiliation(s)
- Yasser Jamil
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States.
| | - Akintayo Akinleye
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States
| | - Mojtaba Mirzaei
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States
| | - Matthew Lempel
- Department of Rheumatology, Yale School of Medicine, New Haven, CT 06510, United States
| | - Kassem Farhat
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States
| | - Samuel Pan
- Department of Infectious Disease, Yale School of Medicine, Waterbury, CT 06708, United States
| |
Collapse
|
22
|
Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 575] [Impact Index Per Article: 287.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
23
|
Tonutti A, Scarfò I, La Canna G, Selmi C, De Santis M. Diagnostic Work-Up in Patients with Nonbacterial Thrombotic Endocarditis. J Clin Med 2023; 12:5819. [PMID: 37762758 PMCID: PMC10532023 DOI: 10.3390/jcm12185819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis that occurs in patients with predisposing conditions, including malignancies, autoimmune diseases (particularly antiphospholipid antibody syndrome, which accounts for the majority of lupus-associated cases), and coagulation disturbances for which the correlation with classical determinants is unclear. The condition is commonly referred to as "marantic", "verrucous", or Libman-Sacks endocarditis, although these are not synonymous, representing clinical-pathological nuances. The clinical presentation of NBTE involves embolic events, while local valvular complications, generally regurgitation, are typically less frequent and milder compared to infective forms of endocarditis. In the past, the diagnosis of NBTE relied on post mortem examinations, while at present, the diagnosis is primarily based on echocardiography, with the priority of excluding infective endocarditis through comprehensive microbiological and serological tests. As in other forms of endocarditis, besides pathology, transesophageal echocardiography remains the diagnostic standard, while other imaging techniques hold promise as adjunctive tools for early diagnosis and differentiation from infective vegetations. These include cardiac MRI and 18FDG-PET/CT, which already represents a major diagnostic criterion of infective endocarditis in specific settings. We will herein provide a comprehensive review of the current knowledge on the clinics and therapeutics of NBTE, with a specific focus on the diagnostic tools.
Collapse
Affiliation(s)
- Antonio Tonutti
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.T.); (C.S.)
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Iside Scarfò
- Applied Diagnostic Echocardiography Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (G.L.C.)
| | - Giovanni La Canna
- Applied Diagnostic Echocardiography Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (G.L.C.)
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.T.); (C.S.)
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.T.); (C.S.)
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| |
Collapse
|
24
|
Pollock A, Kiernan TJ. Contemporary management of infective endocarditis in pregnancy. Expert Rev Cardiovasc Ther 2023; 21:839-854. [PMID: 37915203 DOI: 10.1080/14779072.2023.2276891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Infective endocarditis (IE) during pregnancy is a rare condition that is associated with a high level of morbidity and mortality. The epidemiology, diagnosis, treatment, and prognosis have changed significantly in the last two decades. The declining incidence of rheumatic heart disease, improved life expectancy with congenital heart disease, advances in cardiac surgery and cardiac devices, rise in resistant microorganisms, complications of the opioid epidemic, and increasing maternal age are some of the many factors contributing to these changes. AREAS COVERED This article explores existing literature on the topic including case reports, case series, registry data, and clinical guidelines. The focus of this article is the evolving epidemiology, predisposing factors and preventative measures, clinical presentation, investigation, management, and potential complications of IE in pregnancy. EXPERT OPINION Robust prospective data on the management of IE in pregnancy is lacking, and obtaining these data will be very challenging. It is imperative that international registries are used to provide data on best clinical practices and inform future clinical guidelines. Multimodal imaging should be incorporated in the investigation of complicated cases. A multidisciplinary approach to the management of this rare and life-threatening condition is essential to ensure the best outcomes for both the mother and the fetus.
Collapse
Affiliation(s)
- Ailís Pollock
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Thomas J Kiernan
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| |
Collapse
|
25
|
Polyak A, Képes Z, Trencsényi G. Implant Imaging: Perspectives of Nuclear Imaging in Implant, Biomaterial, and Stem Cell Research. Bioengineering (Basel) 2023; 10:bioengineering10050521. [PMID: 37237591 DOI: 10.3390/bioengineering10050521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Until now, very few efforts have been made to specifically trace, monitor, and visualize implantations, artificial organs, and bioengineered scaffolds for tissue engineering in vivo. While mainly X-Ray, CT, and MRI methods have been used for this purpose, the applications of more sensitive, quantitative, specific, radiotracer-based nuclear imaging techniques remain a challenge. As the need for biomaterials increases, so does the need for research tools to evaluate host responses. PET (positron emission tomography) and SPECT (single photon emission computer tomography) techniques are promising tools for the clinical translation of such regenerative medicine and tissue engineering efforts. These tracer-based methods offer unique and inevitable support, providing specific, quantitative, visual, non-invasive feedback on implanted biomaterials, devices, or transplanted cells. PET and SPECT can improve and accelerate these studies through biocompatibility, inertivity, and immune-response evaluations over long investigational periods at high sensitivities with low limits of detection. The wide range of radiopharmaceuticals, the newly developed specific bacteria, and the inflammation of specific or fibrosis-specific tracers as well as labeled individual nanomaterials can represent new, valuable tools for implant research. This review aims to summarize the opportunities of nuclear-imaging-supported implant research, including bone, fibrosis, bacteria, nanoparticle, and cell imaging, as well as the latest cutting-edge pretargeting methods.
Collapse
Affiliation(s)
- Andras Polyak
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary
| | - Zita Képes
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary
| | - György Trencsényi
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary
| |
Collapse
|
26
|
Ferro P, Boni R, Bartoli F, Lazzeri F, Slart RHJA, Erba PA. Radionuclide Imaging of Infective Endocarditis. Cardiol Clin 2023; 41:233-249. [PMID: 37003680 DOI: 10.1016/j.ccl.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Infective endocarditis (IE) is associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient management. Due to difficulties in the diagnosis, a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data is used. Imaging, including echocardiography, molecular imaging techniques, and coronary CT angiography (CTA) is central to detect infections involving heart valves and implanted cardiovascular devices, also allowing for early detection of septic emboli and metastatic. This article describes the main clinical application of white blood cell SPECT/CT and [18F]FDG-PET/CT and CTA in IE and infections associated with cardiovascular implantable electronic devices.
Collapse
Affiliation(s)
- Paola Ferro
- Nuclear Medicine Department ASST Ospedale Papa Giovanni XXIII Bergamo (Italy), Piazza OMS 1, Bergamo 24127, Italy
| | - Roberto Boni
- Nuclear Medicine Department ASST Ospedale Papa Giovanni XXIII Bergamo (Italy), Piazza OMS 1, Bergamo 24127, Italy
| | - Francesco Bartoli
- Department of Translational Research and Advanced Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Via Roma 57, Pisa I-56126, Italy
| | - Francesca Lazzeri
- Department of Translational Research and Advanced Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Via Roma 57, Pisa I-56126, Italy
| | - Riemer H J A Slart
- Medical Imaging Center, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Paola A Erba
- Department of Medicine and Surgery, University of Milan Bicocca and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII Bergamo (Italy), Piazza OMS 1, Bergamo 24127, Italy.
| |
Collapse
|
27
|
Ferro P, Boni R, Slart RH, Erba PA. Imaging of Endocarditis and Cardiac Device-Related Infections: An Update. Semin Nucl Med 2023; 53:184-198. [PMID: 36740487 DOI: 10.1053/j.semnuclmed.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 02/06/2023]
Abstract
IE is a deadly disease requiring prompt diagnosis for adequate patient's management. The diagnosis requires the integration of clinical signs, microbiology data and imaging data and proper discussion within a multidisciplinary team, the endocarditis team. Since the introduction of 18F-FDG-PET/CT and WBC SPECT/CT in the diagnostic algorithm of PVE the nuclear medicine imaging specialists is active part of the Endocarditis Team, requiring proper knowledge of dedicated imaging acquisition protocols, expertise for imaging reading and interpretations to select the best test or combination of tests for each specific clinical situation. In this manuscript, we will review the main technical aspects of each imaging procedure, the most recent literature with specific regards to special challenging populations and provide clinical examples.
Collapse
Affiliation(s)
- Paola Ferro
- Nuclear Medicine Unit, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| | - Roberto Boni
- Nuclear Medicine Unit, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Riemer Hja Slart
- Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Paola Anna Erba
- Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine and Surgery, University of Milan Bicocca and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
28
|
Hutt E, Kaur S, Jaber WA. Modern tools in cardiac imaging to assess myocardial inflammation and infection. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead019. [PMID: 37006410 PMCID: PMC10063223 DOI: 10.1093/ehjopen/oead019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
Myocardial forms of infection and inflammation are highly heterogeneous in clinical course and presentation but associated with diagnostic and treatment uncertainty, high morbidity, mortality, and financial burden. Historically, these pathologies were diagnosed invasively with biopsy, surgical pathology, or explanted hearts. However, in the current era, the diagnosis has been aided by a variety of non-invasive imaging tools in the appropriate clinical presentation. This review provides a comprehensive understanding of the available imaging modalities for guiding the diagnosis, treatment, and prognosis of cardiac infection and inflammation.
Collapse
Affiliation(s)
- Erika Hutt
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Simrat Kaur
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
| |
Collapse
|
29
|
Contemporary Review of Multi-Modality Cardiac Imaging Evaluation of Infective Endocarditis. Life (Basel) 2023; 13:life13030639. [PMID: 36983795 PMCID: PMC10052933 DOI: 10.3390/life13030639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Infective endocarditis (IE) remains to be a heterogeneous disease with high morbidity and mortality rates, which can affect native valves, prosthetic valves, and intra-cardiac devices, in addition to causing systemic complications. The combination of clinical, laboratory, and cardiac imaging evaluation is critical for early diagnosis and risk stratification of IE. This can facilitate timely medical and surgical management to improve patient outcomes. Key imaging findings for IE include vegetations, valve perforation, prosthetic valve dehiscence, pseudoaneurysms, abscesses, and fistulae. Transthoracic echocardiography continues to be the first-line imaging modality of choice, while transesophageal echocardiography subsequently provides an improved structural assessment and characterization of lesions to facilitate management decision in IE. Recent advances in other imaging modalities, especially cardiac computed tomography and 18F-fluorodeox-yglucose positron emission tomography, and to a lesser extent cardiac magnetic resonance imaging and other nuclear imaging techniques, have demonstrated important roles in providing complementary IE diagnostic and prognostic information. This review aims to discuss the individual and integrated utilities of contemporary multi-modality cardiac imaging for the assessment and treatment guidance of IE.
Collapse
|
30
|
Holcman K, Rubiś P, Ząbek A, Boczar K, Podolec P, Kostkiewicz M. Advances in Molecular Imaging in Infective Endocarditis. Vaccines (Basel) 2023; 11:420. [PMID: 36851297 PMCID: PMC9967666 DOI: 10.3390/vaccines11020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/04/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Infective endocarditis (IE) is a growing epidemiological challenge. Appropriate diagnosis remains difficult due to heterogenous etiopathogenesis and clinical presentation. The disease may be followed by increased mortality and numerous diverse complications. Developing molecular imaging modalities may provide additional insights into ongoing infection and support an accurate diagnosis. We present the current evidence for the diagnostic performance and indications for utilization in current guidelines of the hybrid modalities: single photon emission tomography with technetium99m-hexamethylpropyleneamine oxime-labeled autologous leukocytes (99mTc-HMPAO-SPECT/CT) along with positron emission tomography with fluorodeoxyglucose (18F-FDG PET/CT). The role of molecular imaging in IE diagnostic work-up has been constantly growing due to technical improvements and the increasing evidence supporting its added diagnostic and prognostic value. The various underlying molecular processes of 99mTc-HMPAO-SPECT/CT as well as 18F-FDG PET/CT translate to different imaging properties, which should be considered in clinical practice. Both techniques provide additional diagnostic value in the assessment of patients at risk of IE. Nuclear imaging should be considered in the IE diagnostic algorithm, not only for the insights gained into ongoing infection at a molecular level, but also for the determination of the optimal clinical therapeutic strategies.
Collapse
Affiliation(s)
- Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Krzysztof Boczar
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland
| |
Collapse
|
31
|
Roy SG, Akhtar T, Bandyopadhyay D, Ghosh RK, Hagau R, Ranjan P, Gerard P, Jain D. The Emerging Role of FDG PET/CT in Diagnosing Endocarditis and Cardiac Device Infection. Curr Probl Cardiol 2023; 48:101510. [PMID: 36402219 DOI: 10.1016/j.cpcardiol.2022.101510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Infective endocarditis and cardiac implantable electronic device infection (CIEDI) have witnessed an increasing incidence in clinical practice and associated with increasing health care expenditure. Expanding indications of CIED in various cardiovascular conditions have also contributed to the surge of these infections. Early diagnosis of these infections is associated with a favorable prognosis. Given the lack of a single definitive diagnostic method and the limitations of echocardiography, which is considered a central diagnostic imaging modality, additional imaging modalities are required. Recent studies have highlighted the diagnostic utility of FDG PET and CT. In this review article, we discuss the existing limitations of echocardiography, acquisition protocols of PET/CT, and indications of these advanced imaging modalities in infective endocarditis and CIEDI diagnosis.
Collapse
Affiliation(s)
- Shambo Guha Roy
- Division of radiology, Mercy Catholic Medical Center, Darby, PA
| | - Tauseef Akhtar
- Division of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA.
| | | | - Raktim K Ghosh
- MedStar Heart and Vascular Institute, Union Memorial Hospital, Baltimore, MD
| | - Radu Hagau
- Division of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA
| | - Pragya Ranjan
- Division of Cardiology, New York Medical College at Westchester Medical Center, New York, NY
| | - Perry Gerard
- Division of Cardiology, New York Medical College at Westchester Medical Center, New York, NY
| | - Diwakar Jain
- Division of Cardiology, New York Medical College at Westchester Medical Center, New York, NY
| |
Collapse
|
32
|
Holcman K, Rubiś P, Ćmiel B, Ząbek A, Boczar K, Szot W, Kalarus Z, Graczyk K, Hanarz M, Małecka B, Podolec P, Kostkiewicz M. To what extent does prior antimicrobial therapy affect the diagnostic performance of radiolabeled leukocyte scintigraphy in infective endocarditis? J Nucl Cardiol 2023; 30:343-353. [PMID: 35819715 DOI: 10.1007/s12350-022-03048-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS This prospective, single-center study sought to assess to what extent there is interference between the hybrid technique of single-photon emission tomography-computed tomography with technetium99m-hexamethylpropyleneamine oxime-labeled leukocytes (99mTc-HMPAO-SPECT/CT) and antimicrobial therapy in patients with infective endocarditis (IE). METHODS AND RESULTS During the years 2015-2019, we enrolled 205 consecutive adults with suspected IE, all underwent 99mTc-HMPAO-SPECT/CT. The study population was divided into those who had received antimicrobial therapy up to 30 days prior to 99mTc-HMPAO-SPECT/CT (group 1, n = 96) and those who had not (group 2, n = 109). Patients were prospectively observed for 12 ± 10 months. Group 1 presented higher positive predictive values (91.89% vs. 60.00%, = 0.001), and decreased negative predictive values (77.97% vs. 90.54%, P = 0.04). Patients treated with antimicrobial therapy displayed false-negative 99mTc-HMPAO-SPECT/CT results more often [odds ratio (OR), 4.63; 95% confidence interval (CI), 1.41-15.23, P = .01], particularly when intravenous (OR 5.37; 95% CI 1.73-16.62, P = .004), definite (OR 9.43; 95% CI 2.65-33.51, P = .001), and combination antibiotic regimens (OR 8.1; 95% CI 2.57-25.64, P = .001) had been administered. CONCLUSION Prior antibiotic therapy affects 99mTc-HMPAO-SPECT/CT diagnostic properties. Patients treated with antimicrobial therapy display false-negative 99mTc-HMPAO-SPECT/CT results more often, especially if intravenous, definite, or combination regimens are administered.
Collapse
Affiliation(s)
- Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland.
- Department of Nuclear Medicine, John Paul II Hospital, Krakow, Poland.
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Bogdan Ćmiel
- Faculty of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Boczar
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Wojciech Szot
- Department of Nuclear Medicine, John Paul II Hospital, Krakow, Poland
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Zuzanna Kalarus
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Katarzyna Graczyk
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Maksymilian Hanarz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Barbara Małecka
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
- Department of Nuclear Medicine, John Paul II Hospital, Krakow, Poland
| |
Collapse
|
33
|
Filippi L, Bagni O, Schillaci O. Multimodality radionuclide imaging in fever of unknown origin presenting with a solitary spleen lesion. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC9101993 DOI: 10.1186/s43055-022-00788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Fever of unknown origin (FUO) still represents a serious challenge for clinicians, since it can be related to a wide spectrum of disorders, ranging from infections to malignancies. In this scenario, nuclear medicine can be of value to achieve a correct diagnosis both through positron emission computed tomography (PET/CT) and 99mTc labeled hexamethylpropylene amine oxime (HMPAO) white blood cell (WBC) scintigraphy.
Case presentation
We are presenting the case of 65-year-old male, who was referred to our hospital due to prolonged unexplained fever. He was submitted to abdomen ultrasonography (US) that did not disclose relevant pathological findings. Subsequently, he underwent PET/CT scan with 18F-fluorodeoxyglucose (18F-FDG) that revealed an area of increased tracer uptake in splenic inferior pole. In order to solve differential diagnosis between tumor and infection, he was submitted to 99mTc-HMPAO WBC scintigraphy that resulted negative for sites of pathologic radiolabeled cells’ accumulation but revealed a photopenic area in the splenic inferior pole. The pattern of mismatched uptake between 18F-FDG PET/CT and 99mTc-HMPAO WBC scintigraphy was considered highly suspicious for spleen tumor localization. The patient was scheduled for splenectomy and histology resulted positive for non-Hodgkin lymphoma (NHL) of diffuse large B cell type. After splenectomy, a further 18F-FDG PET/CT revealed the appearance of hypermetabolic hepatic lesions. The patient underwent chemotherapy with complete remission.
Conclusion
Nuclear medicine provides valuable tools for differential diagnosis in FUO. In case of patients presenting solitary lesion of the spleen, the combined use of 18F-FDG PET/CT and 99mTc-HMPAO WBC scintigraphy can provide relevant information to aid clinicians to a correct diagnosis.
Collapse
|
34
|
Hughes D, Linchangco R, Reyaldeen R, Xu B. Expanding utility of cardiac computed tomography in infective endocarditis: A contemporary review. World J Radiol 2022; 14:180-193. [PMID: 36160630 PMCID: PMC9350612 DOI: 10.4329/wjr.v14.i7.180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/26/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
There is increasing evidence on the utility of cardiac computed tomography (CCT) in infective endocarditis (IE) to investigate the valvular pathology, the extra-cardiac manifestations of IE and pre-operative planning. CCT can assist in the diagnosis of perivalvular complications, such as pseudoaneurysms and abscesses, and can help identify embolic events to the lungs or systemic vasculature. CCT has also been shown to be beneficial in the pre-operative planning of patients by delineating the coronary artery anatomy and the major cardiovascular structures in relation to the sternum. Finally, hybrid nuclear/computed tomography techniques have been shown to increase the diagnostic accuracy in prosthetic valve endocarditis. This manuscript aims to provide a contemporary update of the existing evidence base for the use of CCT in IE.
Collapse
Affiliation(s)
- Diarmaid Hughes
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Richard Linchangco
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Reza Reyaldeen
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| |
Collapse
|
35
|
Venet M, Friedberg MK, Mertens L, Baranger J, Jalal Z, Tlili G, Villemain O. Nuclear Imaging in Pediatric Cardiology: Principles and Applications. Front Pediatr 2022; 10:909994. [PMID: 35874576 PMCID: PMC9301385 DOI: 10.3389/fped.2022.909994] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Nuclear imaging plays a unique role within diagnostic imaging since it focuses on cellular and molecular processes. Using different radiotracers and detection techniques such as the single photon emission scintigraphy or the positron emission tomography, specific parameters can be assessed: myocardial perfusion and viability, pulmonary perfusion, ventricular function, flow and shunt quantification, and detection of inflammatory processes. In pediatric and congenital cardiology, nuclear imaging can add complementary information compared to other imaging modalities such as echocardiography or magnetic resonance imaging. In this state-of-the-art paper, we appraise the different techniques in pediatric nuclear imaging, evaluate their advantages and disadvantages, and discuss the current clinical applications.
Collapse
Affiliation(s)
- Maelys Venet
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mark K. Friedberg
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jerome Baranger
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Zakaria Jalal
- Department of Congenital and Pediatric Cardiology, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghoufrane Tlili
- Department of Nuclear Medicine, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Olivier Villemain
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
36
|
Erba PA, Bartoli F, Sollini M, Raffaella B, Zanca R, Enrica E, Lazzeri E. Alternative Nuclear Imaging Tools for Infection Imaging. Curr Cardiol Rep 2022; 24:879-891. [PMID: 35696046 PMCID: PMC9288362 DOI: 10.1007/s11886-022-01708-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
Purpose of Review Cardiovascular infections are serious disease associated with high morbidity and mortality. Their diagnosis is challenging, requiring a proper management for a prompt recognition of the clinical manifestations, and a multidisciplinary approach involving cardiologists, cardiothoracic surgeons, infectious diseases specialist, imagers, and microbiologists. Imaging plays a central role in the diagnostic workout, including molecular imaging techniques. In this setting, two different strategies might be used to image infections: the first is based on the use of agents targeting the microorganism responsible for the infection. Alternatively, we can target the components of the pathophysiological changes of the inflammatory process and/or the host response to the infectious pathogen can be considered. Understanding the strength and limitations of each strategy is crucial to select the most appropriate imaging tool. Recent Findings Currently, multislice computed tomography (MSCT) and nuclear imaging (18F-fluorodeoxyglucose positron emission tomography/computed tomography, and leucocyte scintigraphy) are part of the diagnostic strategies. The main role of nuclear medicine imaging (PET/CT and SPECT/CT) is the confirmation of valve/CIED involvement and/or associated perivalvular infection and the detection of distant septic embolism. Proper patients’ preparation, imaging acquisition, and reconstruction as well as imaging reading are crucial to maximize the diagnostic information. Summary In this manuscript, we described the use of molecular imaging techniques, in particular WBC imaging, in patients with infective endocarditis, cardiovascular implantable electronic device infections, and infections of composite aortic graft, underlying the strength and limitations of such approached as compared to the other imaging modalities.
Collapse
Affiliation(s)
- Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy.
- Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Francesco Bartoli
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Berchiolli Raffaella
- Vascular Surgery Unit, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberta Zanca
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Esposito Enrica
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy
| | - Elena Lazzeri
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy
| |
Collapse
|
37
|
Gawne P, Man F, Blower PJ, T. M. de Rosales R. Direct Cell Radiolabeling for in Vivo Cell Tracking with PET and SPECT Imaging. Chem Rev 2022; 122:10266-10318. [PMID: 35549242 PMCID: PMC9185691 DOI: 10.1021/acs.chemrev.1c00767] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 02/07/2023]
Abstract
The arrival of cell-based therapies is a revolution in medicine. However, its safe clinical application in a rational manner depends on reliable, clinically applicable methods for determining the fate and trafficking of therapeutic cells in vivo using medical imaging techniques─known as in vivo cell tracking. Radionuclide imaging using single photon emission computed tomography (SPECT) or positron emission tomography (PET) has several advantages over other imaging modalities for cell tracking because of its high sensitivity (requiring low amounts of probe per cell for imaging) and whole-body quantitative imaging capability using clinically available scanners. For cell tracking with radionuclides, ex vivo direct cell radiolabeling, that is, radiolabeling cells before their administration, is the simplest and most robust method, allowing labeling of any cell type without the need for genetic modification. This Review covers the development and application of direct cell radiolabeling probes utilizing a variety of chemical approaches: organic and inorganic/coordination (radio)chemistry, nanomaterials, and biochemistry. We describe the key early developments and the most recent advances in the field, identifying advantages and disadvantages of the different approaches and informing future development and choice of methods for clinical and preclinical application.
Collapse
Affiliation(s)
- Peter
J. Gawne
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, SE1 7EH, U.K.
| | - Francis Man
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, SE1 7EH, U.K.
- Institute
of Pharmaceutical Science, School of Cancer
and Pharmaceutical Sciences, King’s College London, London, SE1 9NH, U.K.
| | - Philip J. Blower
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, SE1 7EH, U.K.
| | - Rafael T. M. de Rosales
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, SE1 7EH, U.K.
| |
Collapse
|
38
|
Ramezani Farani M, Aminzadeh Jahromi N, Ali V, Ebrahimpour A, Salehian E, Shafiee Ardestani M, Seyedhamzeh M, Ahmadi S, Sharifi E, Ashrafizadeh M, Rabiee N, Makvandi P. Detection of Dopamine Receptors Using Nanoscale Dendrimer for Potential Application in Targeted Delivery and Whole-Body Imaging: Synthesis and In Vivo Organ Distribution. ACS APPLIED BIO MATERIALS 2022; 5:1744-1755. [DOI: 10.1021/acsabm.2c00118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Marzieh Ramezani Farani
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), the Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, 1417614411, Tehran, Iran
| | - Negin Aminzadeh Jahromi
- School of Pharmacy, International Campus, Tehran University of Medical Sciences, 1417614411, Tehran, Iran
| | - Vahid Ali
- Department of Chemistry, Faculty of Sciences, Islamic Azad University, 19585-466 Rasht, Iran
| | - Anita Ebrahimpour
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, 1417614411, Tehran, Iran
| | - Elnaz Salehian
- Department of Radio-pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, 1417614411, Tehran, Iran
| | - Mehdi Shafiee Ardestani
- Department of Radio-pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, 1417614411, Tehran, Iran
| | - Mohammad Seyedhamzeh
- Department of Radio-pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, 1417614411, Tehran, Iran
| | - Sepideh Ahmadi
- Student Research Committee, Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, 19839-63113 Tehran, Iran
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, 19839-63113 Tehran, Iran
| | - Esmaeel Sharifi
- Institute for Polymers, Composites and Biomaterials, National Research Council (IPCB-CNR), Naples, 80078, Italy
| | - Milad Ashrafizadeh
- Faculty of Engineering and Natural Sciences, Sabanci University, Orta Mahalle, Üniversite Caddesi No. 27, Orhanlı, Tuzla, Istanbul 34956, Turkey
| | - Navid Rabiee
- Department of Physics, Sharif University of Technology, P.O. Box 11155-9161, Tehran, Iran
- School of Engineering, Macquarie University, Sydney, New South Wales 2109, Australia
| | - Pooyan Makvandi
- Istituto Italiano di Tecnologia, Centre for Materials Interfaces, Viale Rinaldo Piaggio 34, 56025 Pontedera, Pisa, Italy
| |
Collapse
|
39
|
Pucar D, William Strauss H. Infective Endocarditis White Blood Cell Imaging: Is There an Added Value to the First-Line Imaging? J Nucl Cardiol 2022; 29:535-539. [PMID: 34228332 DOI: 10.1007/s12350-021-02718-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Darko Pucar
- Section of Nuclear Medicine, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA.
| | - H William Strauss
- Section of Nuclear Medicine, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| |
Collapse
|
40
|
Kooshki N, Grambow-Velilla J, Mahida B, Benali K, Nguyen C, Cimadevilla C, Braham W, Pisani A, Iung B, Raffoul R, Rouzet F, Hyafil F. Diagnostic performance of White Blood Cell SPECT imaging against intra-operative findings in patients with a suspicion of prosthetic valve endocarditis. J Nucl Cardiol 2022; 29:528-534. [PMID: 34085167 DOI: 10.1007/s12350-021-02674-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/04/2021] [Indexed: 01/03/2023]
Abstract
AIM The objective of this study was to evaluate the diagnostic performance of white blood cells (WBC)-SPECT imaging in patients with suspicion of prosthetic valve endocarditis (PVE) against intra-operative findings. METHODS 36 consecutive patients who underwent cardiac surgery 30 days after WBC-SPECT imaging were identified retrospectively. Clinical, imaging, and biological results were collected from reports. WBC-SPECT results were classified as positive or negative and, if positive, the intensity of signal graded as intense or mild. Lesions observed during cardiac surgery were collected from surgeons' reports. RESULTS The 20 patients with positive WBC-SPECT study had confirmed PVE intra-operatively. Patients with intense signal on WBC-SPECT had high prevalence of abscesses (83%) compared to patients with only mild signal (12%). The three patients with negative WBC-SPECT but confirmed PVE had longer duration of antibiotic treatment before imaging and had no perivalvular abscess. Sensitivity, specificity, positive predictive and negative values, and accuracy of WBC-SPECT were measured at 87%, 100%, 100%, 81%, and 92%, respectively. Addition of WBC-SPECT results to the modified Duke score helped re-classify correctly 25% of patients from possible to definite PVE. CONCLUSION In patients with suspicion of PVE, WBC-SPECT imaging provides excellent diagnostic performance against intra-operative findings.
Collapse
Affiliation(s)
- Navid Kooshki
- Department of Nuclear Medicine, Bichat University Hospital, DMU DREAM, Assistance Publique -Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Julia Grambow-Velilla
- Department of Nuclear Medicine, Bichat University Hospital, DMU DREAM, Assistance Publique -Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Besma Mahida
- Department of Nuclear Medicine, Bichat University Hospital, DMU DREAM, Assistance Publique -Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Khadija Benali
- Department of Nuclear Medicine, Bichat University Hospital, DMU DREAM, Assistance Publique -Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Caroline Nguyen
- Department of Cardiology, Bichat University Hospital, DMU DREAM, Assistance Publique-Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Claire Cimadevilla
- Department of Cardiology, Bichat University Hospital, DMU DREAM, Assistance Publique-Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Wael Braham
- Department of Cardiac Surgery, Bichat University Hospital, DMU DREAM, Assistance Publique -Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Angelo Pisani
- Department of Cardiac Surgery, Bichat University Hospital, DMU DREAM, Assistance Publique -Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat University Hospital, DMU DREAM, Assistance Publique-Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Richard Raffoul
- Department of Cardiac Surgery, Bichat University Hospital, DMU DREAM, Assistance Publique -Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - François Rouzet
- Department of Nuclear Medicine, Bichat University Hospital, DMU DREAM, Assistance Publique -Hôpitaux de Paris, University of Paris, 75018, Paris, France
| | - Fabien Hyafil
- Department of Nuclear Medicine, Hôpital Européen Georges-Pompidou, DMU IMAGINA, Assistance Publique -Hôpitaux de Paris, University of Paris, 20 Rue Leblanc, 75015, Paris, France.
| |
Collapse
|
41
|
Mills MT, Al-Mohammad A, Warriner DR. Changes and advances in the field of infective endocarditis. Br J Hosp Med (Lond) 2022; 83:1-11. [DOI: 10.12968/hmed.2021.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infective endocarditis is a rare but deadly disease, with a highly variable presentation. The clinical manifestations of the condition are often multisystemic, ranging from dermatological to ophthalmic, and cardiovascular to renal. Thus, patients with infective endocarditis may first present to the acute or general physician, who may have a variable knowledge of the condition. The diagnosis of infective endocarditis can be challenging, relying on clinical, imaging and microbiological features. Recent decades have seen a transformation in the epidemiology and microbiology of infective endocarditis and yet, despite advances in diagnostics and therapeutics, mortality rates remain high. This review outlines the emerging studies and guidelines on the assessment and management of infective endocarditis, focusing on the evolving epidemiology of the condition, the role of new imaging modalities, updated diagnostic criteria, the latest on antimicrobial and surgical management, and the role of a multidisciplinary approach in the management of patients with infective endocarditis.
Collapse
Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Abdallah Al-Mohammad
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David R Warriner
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
42
|
Gamma camera imaging of infectious endocarditis. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
43
|
PET imaging in cardiovascular infections. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
44
|
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: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease with stable prevalence despite prophylactic, diagnostic, and therapeutic advances. In parallel to the growing number of cardiac devices implanted, the number of patients developing IE on prosthetic valves and cardiac implanted electronic device (CIED) is increasing at a rapid pace. The diagnosis of IE is particularly challenging, and currently relies on the Duke-Li modified classification, which include clinical, microbiological, and imaging criteria. While echocardiography remains the first line imaging technique, especially in native valve endocarditis, the incremental value of two nuclear imaging techniques, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) and white blood cells single photon emission tomography with computed tomography (WBC-SPECT), has emerged for the management of prosthetic valve and CIED IE. In this review, we will summarize the procedures for image acquisition, discuss the role of 18F-FDG-PET/CT and WBC-SPECT imaging in different clinical situations of IE, and review the respective diagnostic performance of these nuclear imaging techniques and their integration into the diagnostic algorithm for patients with a suspicion of IE.
Collapse
Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, Beaujon University Hospital, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110 Clichy, France;
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8006 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, CH-8952 Schlieren, Switzerland
| | - Fabien Hyafil
- Department of Nuclear Medicine, Georges-Pompidou European Hospital, DMU IMAGINA, Assistance Publique-Hôpitaux de Paris, University of Paris, 20 Rue Leblanc, 75015 Paris, France
- Correspondence: ; Tel.: +33-01-56-09-56-24
| |
Collapse
|
45
|
Sollini M, Bartoli F, Boni R, Zanca R, Colli A, Levantino M, Menichetti F, Ferrari M, Berchiolli R, Lazzeri E, Erba PA. Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure. Front Cardiovasc Med 2021; 8:745556. [PMID: 34926606 PMCID: PMC8671629 DOI: 10.3389/fcvm.2021.745556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose: This study aimed to assess the diagnostic performances of multimodal imaging [i.e., white blood cell single-photon emission computed tomography/CT (99mTc-HMPAO-WBC SPECT/CT) and 18-fluoride-fluorodeoxyglucose positron emission tomography/CT ([18F]FDG PET/CT)] in patients with suspected infection after the Bentall procedure, proposing new specific diagnostic criteria for the diagnosis. Methods: Between January 2009 and December 2019, we selected within a cardiovascular infections registry, 76 surgically treated patients (27 women and 49 men, median 66 years, and range 29–83 years). All the patients underwent molecular imaging for a suspected infection after the replacement of the aortic valve and ascending aorta according to the Bentall procedure. We analyzed 98 scans including 49 99mTc-WBC and 49 [18F]FDG PET/CT. A total of 22 patients with very early/early suspected infection (<3 months after surgery) were imaged with both the techniques. Positive imaging was classified according to the anatomical site of increased uptake: to the aortic valve (AV), to both the AV and AV tube graft (AVTG) or to the TG, to surrounding tissue, and/or to extracardiac sites (embolic events or other sites of concomitant infection). Standard clinical workup included in all the patients having echocardiography/CT, blood culture, and the Duke criteria. Pretest probability and positive/negative likelihood ratio were calculated. Sensitivity and specificity of 99mTc labeled hexamethylpropylene amine oxime-WBC SPECT/CT (99mTc-HMPAO-WBC SPECT/CT) and [18F]FDG PET/CT imaging were calculated by using microbiology (n = 35) or clinical follow-up (n = 41) as final diagnosis. 99mTc-HMPAO-WBC scintigraphy and [18F]FDG PET/CT findings were compared with 95% CIs by using the McNemar test to those of echocardiography/CT, blood culture, and the Duke criteria. Results: Sensitivity, specificity, and accuracy of 99mTc-HMPAO-WBC were 86, 92, and 88%, respectively, with a slightly higher sensitivity for tube graft infection (TGI) as compared to isolated AV and combined AVTG. Overall, sensitivity, specificity, and accuracy of [18F]FDG PET/CT were 97, 73, and 90%, respectively. In 22 patients with suspected very early and early postsurgical infections, the two imaging modalities were concordant in 17 cases [10 true positive (TP) and 7 true negative (TN)]. [18F]FDG PET/CT presented a higher sensitivity than 99mTc-HMPAO-WBC scan. 99mTc-HMPAO-WBC scan correctly classified as negative three false-positive (FP) PET/CT findings. Conclusion: Our findings supported the use of 99mTc-HMPAO-WBC SPECT/CT and [18F]FDG PET/CT in patients with suspicion infection after the Bentall procedure early in the course of the disease onset to confirm the diagnosis and provide a comprehensive assessment of disease burden through the proposed criteria.
Collapse
Affiliation(s)
- Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesco Bartoli
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Roberto Boni
- Unità Operativa Complessa Medicina Nucleare, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberta Zanca
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Colli
- Division of Cardiovascular Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Maurizio Levantino
- Division of Cardiovascular Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Mauro Ferrari
- Vascular Surgery, Department of Translational Research and Advanced Technology in Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Raffaella Berchiolli
- Vascular Surgery, Department of Translational Research and Advanced Technology in Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Elena Lazzeri
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Paola A Erba
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.,Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Centre, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
46
|
Eder MD, Upadhyaya K, Park J, Ringer M, Malinis M, Young BD, Sugeng L, Hur DJ. Multimodality Imaging in the Diagnosis of Prosthetic Valve Endocarditis: A Brief Review. Front Cardiovasc Med 2021; 8:750573. [PMID: 34988125 PMCID: PMC8720921 DOI: 10.3389/fcvm.2021.750573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/29/2021] [Indexed: 12/17/2022] Open
Abstract
Infective endocarditis is a common and treatable condition that carries a high mortality rate. Currently the workup of infective endocarditis relies on the integration of clinical, microbiological and echocardiographic data through the use of the modified Duke criteria (MDC). However, in cases of prosthetic valve endocarditis (PVE) echocardiography can be normal or non-diagnostic in a high proportion of cases leading to decreased sensitivity for the MDC. Evolving multimodality imaging techniques including leukocyte scintigraphy (white blood cell imaging), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), multidetector computed tomographic angiography (MDCTA), and cardiac magnetic resonance imaging (CMRI) may each augment the standard workup of PVE and increase diagnostic accuracy. While further studies are necessary to clarify the ideal role for each of these imaging techniques, nevertheless, these modalities hold promise in determining the diagnosis, prognosis, and care of PVE. We start by presenting a clinical vignette, then evidence supporting various modality strategies, balanced by limitations, and review of formal guidelines, when available. The article ends with the authors' summary of future directions and case conclusion.
Collapse
Affiliation(s)
- Maxwell D. Eder
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Krishna Upadhyaya
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
- Ascension Medical Group, Section of Cardiovascular Medicine, Milwaukee, WI, United States
| | - Jakob Park
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT, United States
| | - Matthew Ringer
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
| | - Maricar Malinis
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
| | - Bryan D. Young
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - David J. Hur
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
47
|
Jaber WA, Wang TKM, Cremer PC. PET/CT for endocarditis in the ACC/AHA 2020 valve guidelines: Ready for prime time? J Nucl Cardiol 2021; 28:2422. [PMID: 34296392 DOI: 10.1007/s12350-021-02748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Wael A Jaber
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus J1-5, Cleveland, OH, 44195, USA.
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus J1-5, Cleveland, OH, 44195, USA
| | - Paul C Cremer
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus J1-5, Cleveland, OH, 44195, USA
| |
Collapse
|
48
|
Kirkbride RR, Rawal B, Mirsadraee S, Galperin-Aizenberg M, Wechalekar K, Ridge CA, Litmanovich DE. Imaging of Cardiac Infections: A Comprehensive Review and Investigation Flowchart for Diagnostic Workup. J Thorac Imaging 2021; 36:W70-W88. [PMID: 32852420 DOI: 10.1097/rti.0000000000000552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Infections of the cardiovascular system may present with nonspecific symptoms, and it is common for patients to undergo multiple investigations to arrive at the diagnosis. Echocardiography is central to the diagnosis of endocarditis and pericarditis. However, cardiac computed tomography (CT) and magnetic resonance imaging also play an additive role in these diagnoses; in fact, magnetic resonance imaging is central to the diagnosis of myocarditis. Functional imaging (fluorine-18 fluorodeoxyglucose-positron emission tomography/CT and radiolabeled white blood cell single-photon emission computed tomography/CT) is useful in the diagnosis in prosthesis-related and disseminated infection. This pictorial review will detail the most commonly encountered cardiovascular bacterial and viral infections, including coronavirus disease-2019, in clinical practice and provide an evidence basis for the selection of each imaging modality in the investigation of native tissues and common prostheses.
Collapse
Affiliation(s)
- Rachael R Kirkbride
- Department of Cardiothoracic Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | | | - Maya Galperin-Aizenberg
- Department of Radiology Hospital of the University of Pennsylvania and Perelman School of Medicine, Philadelphia, PA
| | - Kshama Wechalekar
- Department of Nuclear Medicine and PET, Royal Brompton and Harefield Foundation Trust Hospital, London, UK
| | | | - Diana E Litmanovich
- Department of Cardiothoracic Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| |
Collapse
|
49
|
Lo Presti S, Elajami TK, Zmaili M, Reyaldeen R, Xu B. Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis: A contemporary narrative review. World J Cardiol 2021; 13:254-270. [PMID: 34589164 PMCID: PMC8436678 DOI: 10.4330/wjc.v13.i8.254] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis is one of the leading life-threatening infections around the world. With the exponential growth in the field of transcatheter interventions and advances in specialized surgical techniques, the number of prosthetic valves and cardiac implantable devices has significantly increased. This has led to a steep rise in the number of cases of prosthetic valve endocarditis (PVE) comprising up to 30% of all cases. Clinical guidelines rely on the use of the modified Duke criteria; however, the diagnostic sensitivity of the modified Duke criteria is reduced in the context of PVE. This is in part attributed to prosthesis related artifact which greatly affects the ability of echocardiography to detect early infective changes related to PVE in certain cases. There has been increasing recognition of the roles of complementary imaging modalities and updates in international society recommendations. Prompt diagnosis and treatment can prevent the devastating consequences of this condition. Imaging modalities such as cardiac computed tomography and 18-fluorodeoxyglucose positron emission tomography/computed tomography are diagnostic tools that provide a complementary role to echocardiography in aiding diagnosis, pre-operative planning, and treatment decision-making process in these challenging cases. Understanding the strengths and limitations of these adjuvant imaging modalities is crucial for the implementation of appropriate imaging modalities in clinical practice.
Collapse
Affiliation(s)
- Saberio Lo Presti
- Advanced Cardiac Imaging Fellows, Sydell and Arnold Miller Family Heart Vascular and Thoracic Institute at Cleveland Clinic, Cleveland, OH 44195, United States
| | - Tarec K Elajami
- Department of Cardiology, Mount Sinai Medical Center, Miami Beach, FL 33140, United States
| | - Mohammad Zmaili
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Reza Reyaldeen
- Advanced Cardiac Imaging Fellows, Sydell and Arnold Miller Family Heart Vascular and Thoracic Institute at Cleveland Clinic, Cleveland, OH 44195, United States
| | - Bo Xu
- Section of Cardiovascular Imaging in the Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular and Thoracic Institute at Cleveland Clinic, Cleveland, OH 44195, United States.
| |
Collapse
|
50
|
Rojas-Moreno C. Systematic Whole-body 18F-FDG PET/CT in Infective Endocarditis: Are We There Yet? Clin Infect Dis 2021; 73:404-405. [PMID: 32479617 DOI: 10.1093/cid/ciaa665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christian Rojas-Moreno
- Division of Infectious Diseases, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| |
Collapse
|