Cardiac 18F-FDG PET/CT procedure for the diagnosis of prosthetic endocarditis and intracardiac devices

Rev Esp Med Nucl Imagen Mol (Engl Ed). 2018 May-Jun;37(3):163-171. doi: 10.1016/j.remn.2018.01.002. Epub 2018 Feb 26.
[Article in English, Spanish]

Abstract

Infective endocarditis (IE) is a serious condition with a poor prognosis, its mortality unchanged significantly despite diagnostic and therapeutic advances in the last 30years. The diagnostic ability of the modified Duke criteria in prosthetic endocarditis and/or devices does not exceed 50%, so new tools are necessary for the diagnosis of this entity in this context. The 18F-FDG PET/CTA combines a highly sensitive technique to detect inflammatory-infectious activity with a technique with high anatomical resolution to assess the structural lesions associated with endocarditis. With a diagnostic sensitivity between 91-97%, this hybrid technique has become a useful diagnostic tool for patients with prosthetic valves or devices and suspicion of IE, becoming a major criterion in the diagnostic algorithm of current guidelines. This excellent diagnostic ability depends directly on the quality of the obtained exploration and the knowledge at the time of interpreting the images. The aim of this review is to describe and standardize the methodology of cardiac 18F-FDG PET/CTA in the diagnosis of endocarditis in prosthetic valves and intracardiac devices, with special emphasis on the particularities of the patient's preparation, the PET and CT acquisition procedures, and the subsequent imaging postprocessing and interpretation.

Keywords: (18)F-FDG; Dispositivos intracardíacos; Endocarditis infecciosa; Frenación miocárdica; Infective endocarditis; Intracardiac devices; Myocardial suppression uptake; PET/CT; PET/TC; Prosthetic valves; Válvulas protésicas.

Publication types

  • Review

MeSH terms

  • Computed Tomography Angiography / methods
  • Diet, Carbohydrate-Restricted
  • Dietary Fats
  • Endocarditis / diagnostic imaging*
  • Endocarditis / etiology
  • Fasting
  • Fluorine Radioisotopes / pharmacokinetics
  • Fluorodeoxyglucose F18 / pharmacokinetics
  • Glycolysis
  • Heart Valve Prosthesis / adverse effects*
  • Heparin / administration & dosage
  • Heparin / pharmacology
  • Humans
  • Leukocytes / metabolism
  • Macrophages / metabolism
  • Myocardium / metabolism
  • Myocytes, Cardiac / metabolism
  • Phosphorylation
  • Positron Emission Tomography Computed Tomography / methods*
  • Prostheses and Implants / adverse effects*
  • Prosthesis-Related Infections / diagnostic imaging*
  • Radiopharmaceuticals / pharmacokinetics

Substances

  • Dietary Fats
  • Fluorine Radioisotopes
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Heparin
  • Fluorine-18