Christopher Hohmann1, Guido Michels1, Matthias Schmidt2, Roman Pfister1, Navid Mader3, Myriam Ohler4, Lara Blanke4, Nathalie Jazmati5, Clara Lehmann4,6,7, Jan Rybniker4,6,7, Sarah M Fünger4, Gerd Fätkenheuer4,6, Norma Jung8. 1. Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany. 2. Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany. 3. Department of Cardiac Surgery, University Hospital of Cologne, Cologne, Germany. 4. Department I of Internal Medicine, University of Cologne, KerpenerStraße 62, 50937, Cologne, Germany. 5. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany. 6. German Center for Infection Research (DZIF), Bonn-Cologne, Cologne, Germany. 7. Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany. 8. Department I of Internal Medicine, University of Cologne, KerpenerStraße 62, 50937, Cologne, Germany. norma.jung@uk-koeln.de.
Abstract
PURPOSE: Despite developments in both imaging and microbiological techniques, the final diagnosis of IE often remains challenging. In this single-center cohort study, we aimed to identify the specific indications for request of 18F-FDG-PET/CT in clinical practice and to evaluate the diagnostic benefit of this nuclear imaging technique. METHODS: A total of 235 patients with possible (n = 43) or definite (n = 192) IE according to the revised Duke criteria were prospectively studied from July 2013 until December 2016. Echocardiography was generally used as the primary cardiac imaging technique. All patients were treated by a multidisciplinary Endocarditis Team. Diagnostics with 18F-FDG-PET/CT were undertaken on request by at least one member of the multidisciplinary team when overall diagnostics were inconclusive. RESULTS: In 20 patients, 18F-FDG-PET/CT scan was performed for additional diagnostic evaluation. Hereof, 15 patients had a history of implanted cardiac prosthetic material. In six patients with definite IE, the use of 18F-FDG-PET/CT was helpful for further clarification of the diagnosis. In one patient with possible IE, the diagnosis could be reclassified to definite IE. In addition, one case of vertebral osteomyelitis as well as upper and lower leg abscesses and knee empyema were detectable as extracardiac foci. Furthermore, 18F-FDG-PET/CT leads to a modification of the management in five patients. CONCLUSION: Our findings support the utility of 18F-FDG-PET/CT as an adjunctive diagnostic tool especially in the evaluation of prosthetic valve-/cardiac device-related IE and for the detection of extracardiac foci in some cases. However, due to remaining limitations also of this imaging technique, a multidisciplinary clinical evaluation still remains the essential basis for the diagnostic assessment.
PURPOSE: Despite developments in both imaging and microbiological techniques, the final diagnosis of IE often remains challenging. In this single-center cohort study, we aimed to identify the specific indications for request of 18F-FDG-PET/CT in clinical practice and to evaluate the diagnostic benefit of this nuclear imaging technique. METHODS: A total of 235 patients with possible (n = 43) or definite (n = 192) IE according to the revised Duke criteria were prospectively studied from July 2013 until December 2016. Echocardiography was generally used as the primary cardiac imaging technique. All patients were treated by a multidisciplinary Endocarditis Team. Diagnostics with 18F-FDG-PET/CT were undertaken on request by at least one member of the multidisciplinary team when overall diagnostics were inconclusive. RESULTS: In 20 patients, 18F-FDG-PET/CT scan was performed for additional diagnostic evaluation. Hereof, 15 patients had a history of implanted cardiac prosthetic material. In six patients with definite IE, the use of 18F-FDG-PET/CT was helpful for further clarification of the diagnosis. In one patient with possible IE, the diagnosis could be reclassified to definite IE. In addition, one case of vertebral osteomyelitis as well as upper and lower leg abscesses and knee empyema were detectable as extracardiac foci. Furthermore, 18F-FDG-PET/CT leads to a modification of the management in five patients. CONCLUSION: Our findings support the utility of 18F-FDG-PET/CT as an adjunctive diagnostic tool especially in the evaluation of prosthetic valve-/cardiac device-related IE and for the detection of extracardiac foci in some cases. However, due to remaining limitations also of this imaging technique, a multidisciplinary clinical evaluation still remains the essential basis for the diagnostic assessment.
Authors: J S Li; D J Sexton; N Mick; R Nettles; V G Fowler; T Ryan; T Bashore; G R Corey Journal: Clin Infect Dis Date: 2000-04-03 Impact factor: 9.079
Authors: María N Pizzi; Albert Roque; Nuria Fernández-Hidalgo; Hug Cuéllar-Calabria; Ignacio Ferreira-González; María T Gonzàlez-Alujas; Gerard Oristrell; Laura Gracia-Sánchez; Juan J González; José Rodríguez-Palomares; Manuel Galiñanes; Olga Maisterra-Santos; David Garcia-Dorado; Joan Castell-Conesa; Benito Almirante; Santiago Aguadé-Bruix; Pilar Tornos Journal: Circulation Date: 2015-08-14 Impact factor: 29.690
Authors: G Habib; G Derumeaux; J F Avierinos; J P Casalta; F Jamal; F Volot; M Garcia; J Lefevre; F Biou; A Maximovitch-Rodaminoff; P E Fournier; P Ambrosi; J G Velut; A Cribier; J R Harle; P J Weiller; D Raoult; R Luccioni Journal: J Am Coll Cardiol Date: 1999-06 Impact factor: 24.094
Authors: Tim Wollenweber; Philipp Roentgen; Andreas Schäfer; Imke Schatka; Caroline Zwadlo; Thomas Brunkhorst; Georg Berding; Johann Bauersachs; Frank M Bengel Journal: Circ Cardiovasc Imaging Date: 2014-07-21 Impact factor: 7.792
Authors: Mark J Dayer; Simon Jones; Bernard Prendergast; Larry M Baddour; Peter B Lockhart; Martin H Thornhill Journal: Lancet Date: 2014-11-18 Impact factor: 79.321
Authors: Riemer H J A Slart; Andor W J M Glaudemans; Olivier Gheysens; Mark Lubberink; Tanja Kero; Marc R Dweck; Gilbert Habib; Oliver Gaemperli; Antti Saraste; Alessia Gimelli; Panagiotis Georgoulias; Hein J Verberne; Jan Bucerius; Christoph Rischpler; Fabien Hyafil; Paola A Erba Journal: Eur Heart J Cardiovasc Imaging Date: 2020-12-01 Impact factor: 6.875
Authors: Riemer H J A Slart; Andor W J M Glaudemans; Olivier Gheysens; Mark Lubberink; Tanja Kero; Marc R Dweck; Gilbert Habib; Oliver Gaemperli; Antti Saraste; Alessia Gimelli; Panagiotis Georgoulias; Hein J Verberne; Jan Bucerius; Christoph Rischpler; Fabien Hyafil; Paola A Erba Journal: Eur J Nucl Med Mol Imaging Date: 2020-10-27 Impact factor: 9.236