Background/Aim: Despite advances in medical imaging, infection of cardiovascular (CVS) devices remains a challenging diagnostic problem. Accurate and timely diagnosis typically requires the correlation of imaging findings with laboratory data. 99mTcRHMPAORWBC SPECT/CT has high diagnostic yield in CVS infection, accurately defining the disease extent. The use of [18F]FDG PET/CT for assessing CVS device infections is also rapidly growing, despite certain wellRknown drawbacks. To better clarify the role of these two imaging procedures we evaluated with [18F]FDG PET/CT and 99mTcRHMPAORWBC SPECT/CT within 7 days from each other. Patients and method: 12 patients with suspected CVS device infection (aortic valve n=4, aortic valve + thoracic aorta prosthesis n=5, vascular graft n=3) were enrolled. When interpreting images, we considered positive for infection any site showing increasing uptake of radiolabelled WBCs from early to late and delayed images for 99mTcRHMPAORWBC scintigraphy, and the appearance of focal [18F]FDG uptake around the device for PET/CT, respectively. Results of the procedures were compared with transthoracic and/or transesophageal ecocardiographic findings, contrastRenhanced CT, microbiology, response to treatment, and clinical followRup. Results: According to the criteria described above, PET/CT and 99mTcRHMPAORWBC imaging were concordantly trueRpositive in 6/12 and trueRnegative in 1 case. Imaging results were discordant in 5 patients (all with a negative 99mTcRHMPAORWBC scan). Three patients presented falseRpositive results at PET/CT, that were in 2 cases of early aortic mechanical valve suspected endocarditis and in 1 case of suspected vascular graft infection. [18F]FDG PET/CT detected lung cancer and vasculitis as the sustaining causes of fever in the remaining two patients with suspected vascular prosthesis infection and endocarditis, respectively. Conclusions: Although preliminary, these results suggest that even with the aid of specific interpretation criteria for [18F]FDG, falseRpositive findings at PET/CT should be always considered and adequately ruled out, particularly in early postRsurgical infections.

Comparison of [18F]FDG PET/CT and 99mTc-HMPAO-labeled leukocyte (99mTc-HMPAO-WBC) SPECT/CT in patients with cardiovascular device infection. Eanm'14

ERBA, PAOLA ANNA;E. Lazzeri;MARCONI, MICHELE;FERRARI, MAURO;MARIANI, GIULIANO
2014-01-01

Abstract

Background/Aim: Despite advances in medical imaging, infection of cardiovascular (CVS) devices remains a challenging diagnostic problem. Accurate and timely diagnosis typically requires the correlation of imaging findings with laboratory data. 99mTcRHMPAORWBC SPECT/CT has high diagnostic yield in CVS infection, accurately defining the disease extent. The use of [18F]FDG PET/CT for assessing CVS device infections is also rapidly growing, despite certain wellRknown drawbacks. To better clarify the role of these two imaging procedures we evaluated with [18F]FDG PET/CT and 99mTcRHMPAORWBC SPECT/CT within 7 days from each other. Patients and method: 12 patients with suspected CVS device infection (aortic valve n=4, aortic valve + thoracic aorta prosthesis n=5, vascular graft n=3) were enrolled. When interpreting images, we considered positive for infection any site showing increasing uptake of radiolabelled WBCs from early to late and delayed images for 99mTcRHMPAORWBC scintigraphy, and the appearance of focal [18F]FDG uptake around the device for PET/CT, respectively. Results of the procedures were compared with transthoracic and/or transesophageal ecocardiographic findings, contrastRenhanced CT, microbiology, response to treatment, and clinical followRup. Results: According to the criteria described above, PET/CT and 99mTcRHMPAORWBC imaging were concordantly trueRpositive in 6/12 and trueRnegative in 1 case. Imaging results were discordant in 5 patients (all with a negative 99mTcRHMPAORWBC scan). Three patients presented falseRpositive results at PET/CT, that were in 2 cases of early aortic mechanical valve suspected endocarditis and in 1 case of suspected vascular graft infection. [18F]FDG PET/CT detected lung cancer and vasculitis as the sustaining causes of fever in the remaining two patients with suspected vascular prosthesis infection and endocarditis, respectively. Conclusions: Although preliminary, these results suggest that even with the aid of specific interpretation criteria for [18F]FDG, falseRpositive findings at PET/CT should be always considered and adequately ruled out, particularly in early postRsurgical infections.
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/697863
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact