Yeungnam Univ J Med.  2021 Apr;38(2):95-106. 10.12701/yujm.2020.00479.

F-18 fluorodeoxyglucose positron emission tomography/computed tomography in the infection of heart

Affiliations
  • 1Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu, Korea

Abstract

Infections involving the heart are becoming increasingly common, and a timely diagnosis of utmost importance, despite its challenges. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a recently introduced diagnostic tool in cardiology. This review focuses on the current evidence for the use of FDG PET/CT in the diagnosis of infective endocarditis, cardiac implantable device infection, left ventricular assist device infection, and secondary complications. The author discusses considerations when using FDG PET/CT in routine clinical practice, patient preparation for reducing physiologic myocardial uptake, acquisition of images, and interpretation of PET/CT findings. This review also functions to highlight the need for a standardized acquisition protocol.

Keyword

Endocarditis; Fluorodeoxyglucose F18; Infections; Positron emission tomography computed tomography; Heart valve prosthesis

Figure

  • Fig. 1. Two patients (A–D and E–H) with suspected cardiac implantable electronic device (CIED) infection. (A) Gross photo showing CIED exposure with redness in a 79-year-old woman. (B) Echocardiography reveals vegetation in the mitral valve. (C, D) Axial FDG PET/CT shows no FDG uptake in the CIED pocket, but shows high uptake in the mitral valve. The patient did not undergo extraction of the CIED, and instead, was treated with vancomycin for CIED-infective endocarditis with positive blood culture for Staphylococcus epidermidis. (E) Gross photo showing pus drainage from the pacemaker insertion site in a 73-year-old man with positive wound culture for Serratia marcescens. (F) Echocardiography confirming absence of abnormal findings in the heart. (G, H) Axial and coronal FDG PET/CT shows increased FDG uptake in the pocket and along the lead. The patient underwent pacemaker removal. FDG, F-18 fluorodeoxyglucose; PET/CT, positron emission tomography/computed tomography.

  • Fig. 2. (A) Extracardiac metastatic infection in a 51-year-old woman demonstrating bilateral lung infection and spondylodiscitis resulting from Staphylococcus aureus. (B) Axial FDG PET, (C) axial FDG PET/CT, and (D) axial lung CT showing extensive lung septic emboli. (E) Sagittal FDG PET/CT, (F) sagittal FDG PET, and (G) coronal FDG PET/CT showing infective spondylodiscitis in T10 to T11. FDG, F-18 fluorodeoxyglucose; PET, positron emission tomography; CT, computed tomography.

  • Fig. 3. (A) Axial FDG ETP/CT, (B) non-attenuation, and (C) AC PET images of a case of definite infective endocarditis (IE) resulting from Escherichia coli in an 89-year-old patient with a mitral native valve. She suffered from fever of unknown origin, and FDG PET/CT was performed to evaluate the source of the fever. FDG PET/CT shows focal areas of enhanced glycolytic metabolism (arrow) around the calcified mitral valve, in which the standard uptake value was 5.8. Dense calcification can result in false uptake through AC, and therefore, readers should check for non-AC PET. FDG, F-18 fluorodeoxyglucose; PET, positron emission tomography; CT, computed tomography.


Reference

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