Albert Roque1,2,3,4, María N Pizzi3,4,5, Nuria Fernández-Hidalgo3,4,6, Eduard Permanyer7, Hug Cuellar-Calabria1,2,3,4, Guillermo Romero-Farina4,5, Remedios Ríos3,8, Benito Almirante3,6, Joan Castell-Conesa2,3,9, Manuel Escobar1,2, Ignacio Ferreira-González3,5,10, Pilar Tornos3,11, Santiago Aguadé-Bruix3,9. 1. Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain. 2. IDI (Institut de Diagnòstic per la Imatge), Spain. 3. Universitat Autònoma de Barcelona, Spain. 4. Vall d'Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, Barcelona, Spain. 5. Department of Cardiology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain. 6. Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain. 7. Department of Cardiac Surgery, Quirónsalud Teknon Heart Institute, Carrer de Vilana 12, Barcelona, Spain. 8. Department of Cardiac Surgery, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain. 9. Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 10. CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. 11. Department of Cardiology, Hospital Quirónsalud, Plaça d'Alfonso Comín 5, Barcelona, Spain.
Abstract
AIMS: To define characteristic PET/CTA patterns of FDG uptake and anatomic changes following prosthetic heart valves (PVs) implantation over time, to help not to misdiagnose post-operative inflammation and avoid false-positive cases. METHODS AND RESULTS: Prospective evaluation of 37 post-operative patients without suspected infection that underwent serial cardiac PET/CTA examinations at 1, 6, and 12 months after surgery, in which metabolic features (FDG uptake distribution pattern and intensity) and anatomic changes were evaluated. Standardized uptake values (SUVs) were obtained and a new measure, the valve uptake index (VUI), (SUVmax-SUVmean)/SUVmax, was tested to homogenize SUV results.In total, 111 PET/CTA scans were performed in 37 patients (19 aortic and 18 mitral valves). FDG uptake was visually detectable in 79.3% of patients and showed a diffuse, homogeneous distribution pattern in 93%. Quantitative analysis yielded a mean maximum standardized uptake value (SUVmax) of 4.46 ± 1.50 and VUI of 0.35 ± 0.10. There were no significant differences in FDG distribution or uptake values between 1, 6, or 12 months. No abnormal anatomic changes or endocarditis lesions were detected in any patient during follow-up. CONCLUSIONS: FDG uptake, often seen in recently implanted PVs, shows a characteristic pattern of post-operative inflammation and, in the absence of associated anatomic lesions, could be considered a normal finding. These features remain stable for at least 1 year after surgery, so questioning the recommended 3-month safety period. A new measure, the VUI, can be useful for evaluating the FDG distribution pattern. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To define characteristic PET/CTA patterns of FDG uptake and anatomic changes following prosthetic heart valves (PVs) implantation over time, to help not to misdiagnose post-operative inflammation and avoid false-positive cases. METHODS AND RESULTS: Prospective evaluation of 37 post-operative patients without suspected infection that underwent serial cardiac PET/CTA examinations at 1, 6, and 12 months after surgery, in which metabolic features (FDG uptake distribution pattern and intensity) and anatomic changes were evaluated. Standardized uptake values (SUVs) were obtained and a new measure, the valve uptake index (VUI), (SUVmax-SUVmean)/SUVmax, was tested to homogenize SUV results.In total, 111 PET/CTA scans were performed in 37 patients (19 aortic and 18 mitral valves). FDG uptake was visually detectable in 79.3% of patients and showed a diffuse, homogeneous distribution pattern in 93%. Quantitative analysis yielded a mean maximum standardized uptake value (SUVmax) of 4.46 ± 1.50 and VUI of 0.35 ± 0.10. There were no significant differences in FDG distribution or uptake values between 1, 6, or 12 months. No abnormal anatomic changes or endocarditis lesions were detected in any patient during follow-up. CONCLUSIONS: FDG uptake, often seen in recently implanted PVs, shows a characteristic pattern of post-operative inflammation and, in the absence of associated anatomic lesions, could be considered a normal finding. These features remain stable for at least 1 year after surgery, so questioning the recommended 3-month safety period. A new measure, the VUI, can be useful for evaluating the FDG distribution pattern. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Myo Thidar Lwin; Victor Tsoi; Tat Yam; Aisling Carroll; Tony Salmon; Stephen Harden; Lindsay Smith Journal: Eur Heart J Case Rep Date: 2021-03-31