Role of radionuclide imaging for diagnosis of device and prosthetic valve infections

Jean-François Sarrazin, François Philippon, Mikaël Trottier, Michel Tessier, Jean-François Sarrazin, François Philippon, Mikaël Trottier, Michel Tessier

Abstract

Cardiovascular implantable electronic device (CIED) infection and prosthetic valve endocarditis (PVE) remain a diagnostic challenge. Cardiac imaging plays an important role in the diagnosis and management of patients with CIED infection or PVE. Over the past few years, cardiac radionuclide imaging has gained a key role in the diagnosis of these patients, and in assessing the need for surgery, mainly in the most difficult cases. Both 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and radiolabelled white blood cell single-photon emission computed tomography/computed tomography (WBC SPECT/CT) have been studied in these situations. In their 2015 guidelines for the management of infective endocarditis, the European Society of Cardiology incorporated cardiac nuclear imaging as part of their diagnostic algorithm for PVE, but not CIED infection since the data were judged insufficient at the moment. This article reviews the actual knowledge and recent studies on the use of 18F-FDG PET/CT and WBC SPECT/CT in the context of CIED infection and PVE, and describes the technical aspects of cardiac radionuclide imaging. It also discusses their accepted and potential indications for the diagnosis and management of CIED infection and PVE, the limitations of these tests, and potential areas of future research.

Keywords: Device; Endocarditis; Fluorodeoxyglucose; Imaging; Infection; Leukocytes; Positron emission tomography/computed tomography; Prosthetic valve; Radionuclide; Scintigraphy.

Conflict of interest statement

Conflict-of-interest statement: No conflicts of interest.

Figures

Figure 1
Figure 1
Different modalities in cardiac nuclear imaging. A: Planar scintigraphy with a single two-dimensional image; B: Single photon emission computed tomography (SPECT) displayed as transverse, sagittal, coronal and MIP attenuation corrected (top row) and uncorrected images (bottom row); C: Hybrid SPECT/CT with precisely registered CT image.
Figure 2
Figure 2
Proposed algorithms incorporating 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation and management of patients with possible device infection. A: Initial CIED infection suspicion; B: Patients with cardiac device and bacteremia or fever of unknown origin (FUO) (Reprinted from Sarrazin JF, Philippon F, Tessier M, Guimond J, Molin F, Champagne J, Nault I, Blier L, Nadeau M, Charbonneau L, Trottier M, O’Hara G. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. J Am Coll Cardiol 2012; 59: 1616-1625, with permission from Elsevier). CIED: Cardiovascular implantable electronic device; PET/CT: Positron emission tomography/computed tomography; TEE: Transesophageal echocardiography.
Figure 3
Figure 3
Positive 18F-fluorodeoxyglucose positron emission tomography/computed tomography in a patient with a deep pocket infection shown by focal 18F-fluorodeoxyglucose uptake just underneath the generator (red arrow). A: SPECT displayed as transverse, sagittal, and coronal attenuation corrected (top row) and uncorrected images (bottom row); B: Hybrid SPECT/CT displayed as transverse, sagittal, and coronal images. SPECT/CT: Single-photon emission computed tomography/computed tomography.
Figure 4
Figure 4
Positive 18F-fluorodeoxyglucose positron emission tomography/computed tomography in a patient with a lead infection (red arrow). A: SPECT displayed as transverse, sagittal, and coronal attenuation corrected (top row) and uncorrected images (bottom row); B: Hybrid SPECT/CT displayed as transverse, sagittal, and coronal images. SPECT/CT: Single-photon emission computed tomography/computed tomography.
Figure 5
Figure 5
Positive 111In white blood cell single-photon emission computed tomography/computed tomography in a patient with endocarditis following an aortic valve replacement (red arrow). A: SPECT displayed as transverse, sagittal, and coronal attenuation corrected (top row) and uncorrected images (bottom row); B: Hybrid SPECT/CT displayed as transverse, sagittal, and coronal images. SPECT/CT: Single-photon emission computed tomography/computed tomography.
Figure 6
Figure 6
European Society of Cardiology 2015 algorithm for diagnosis of infective endocarditis. Reprinted from Habib G, Lancelloti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL; Document Reviewers, Erol Ç, Nihoyannopoulos P, Aboyans V, Agewall S, Athanassopoulos G, Aytekin S, Benzer W, Bueno H, Broekhuizen L, Carerj S, Cosyns B, De Backer J, De Bonis M, Dimopoulos K, Donal E, Drexel H, Flachskampf FA, Hall R, Halvorsen S, Hoen B, Kirchhof P, Lainscak M, Leite-Moreira AF, Lip GY, Mestres CA, Piepoli MF, Punjabi PP, Rapezzi C, Rosenhek R, Siebens K, Tamargo J, Walker DM. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery, the European Association of Nuclear Medicine. Eur Heart J 2015; 36: 3075-3128. Reprinted by permission of Oxford University Press (UK)© European Society of Cardiology, www.escardio.org/. This image/content is not covered by the terms of the Creative Commons license of this publication. For permission to reuse, please contact the rights holder). aMay include cerebral MRI, whole body CT, and/or PET/CT; CT: Computed tomography; FDG: Fluorodeoxyglucose IE: Infective endocarditis; PET: Positron emission tomography; SPECT: Single-photon emission computed tomography; TTE: Transthoracic echocardiography; 18F-FDG PET/CT: 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

References

    1. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) Eur Heart J. 2015;36:3075–3128.
    1. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Ryan T, Bashore T, Corey GR. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–638.
    1. Prendergast BD. Diagnostic criteria and problems in infective endocarditis. Heart. 2004;90:611–613.
    1. Habib G, Derumeaux G, Avierinos JF, Casalta JP, Jamal F, Volot F, Garcia M, Lefevre J, Biou F, Maximovitch-Rodaminoff A, et al. Value and limitations of the Duke criteria for the diagnosis of infective endocarditis. J Am Coll Cardiol. 1999;33:2023–2029.
    1. Thuny F, Grisoli D, Cautela J, Riberi A, Raoult D, Habib G. Infective endocarditis: prevention, diagnosis, and management. Can J Cardiol. 2014;30:1046–1057.
    1. Vilacosta I, Graupner C, San Román JA, Sarriá C, Ronderos R, Fernández C, Mancini L, Sanz O, Sanmartín JV, Stoermann W. Risk of embolization after institution of antibiotic therapy for infective endocarditis. J Am Coll Cardiol. 2002;39:1489–1495.
    1. Botelho-Nevers E, Thuny F, Casalta JP, Richet H, Gouriet F, Collart F, Riberi A, Habib G, Raoult D. Dramatic reduction in infective endocarditis-related mortality with a management-based approach. Arch Intern Med. 2009;169:1290–1298.
    1. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Cosyns B, Fox K, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010;11:202–219.
    1. Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015;132:1435–1486.
    1. Gamelli RL, Liu H, He LK, Hofmann CA. Augmentations of glucose uptake and glucose transporter-1 in macrophages following thermal injury and sepsis in mice. J Leukoc Biol. 1996;59:639–647.
    1. Fukuzumi M, Shinomiya H, Shimizu Y, Ohishi K, Utsumi S. Endotoxin-induced enhancement of glucose influx into murine peritoneal macrophages via GLUT1. Infect Immun. 1996;64:108–112.
    1. Mochizuki T, Tsukamoto E, Kuge Y, Kanegae K, Zhao S, Hikosaka K, Hosokawa M, Kohanawa M, Tamaki N. FDG uptake and glucose transporter subtype expressions in experimental tumor and inflammation models. J Nucl Med. 2001;42:1551–1555.
    1. Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med. 1992;33:1972–1980.
    1. Yamada S, Kubota K, Kubota R, Ido T, Tamahashi N. High accumulation of fluorine-18-fluorodeoxyglucose in turpentine-induced inflammatory tissue. J Nucl Med. 1995;36:1301–1306.
    1. Coulden R, Chung P, Sonnex E, Ibrahim Q, Maguire C, Abele J. Suppression of myocardial 18F-FDG uptake with a preparatory “Atkins-style” low-carbohydrate diet. Eur Radiol. 2012;22:2221–2228.
    1. Persson E. Lipoprotein lipase, hepatic lipase and plasma lipolytic activity. Effects of heparin and a low molecular weight heparin fragment (Fragmin) Acta Med Scand Suppl. 1988;724:1–56.
    1. Ahmed FZ, James J, Memmott MJ, Arumugam P. Radionuclide Imaging of Cardiovascular Infection. Cardiol Clin. 2016;34:149–165.
    1. de Vries EF, Roca M, Jamar F, Israel O, Signore A. Guidelines for the labelling of leucocytes with (99m)Tc-HMPAO. Inflammation/Infection Taskgroup of the European Association of Nuclear Medicine. Eur J Nucl Med Mol Imaging. 2010;37:842–848.
    1. Voigt A, Shalaby A, Saba S. Rising rates of cardiac rhythm management device infections in the United States: 1996 through 2003. J Am Coll Cardiol. 2006;48:590–591.
    1. Greenspon AJ, Patel JD, Lau E, Ochoa JA, Frisch DR, Ho RT, Pavri BB, Kurtz SM. 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008. J Am Coll Cardiol. 2011;58:1001–1006.
    1. Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, Masoudi FA, Okum EJ, Wilson WR, Beerman LB, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010;121:458–477.
    1. Dundar C, Tigen K, Tanalp C, Izgi A, Karaahmet T, Cevik C, Erkol A, Oduncu V, Kirma C. The prevalence of echocardiographic accretions on the leads of patients with permanent pacemakers. J Am Soc Echocardiogr. 2011;24:803–807.
    1. Vos FJ, Bleeker-Rovers CP, van Dijk AP, Oyen WJ. Detection of pacemaker and lead infection with FDG-PET. Eur J Nucl Med Mol Imaging. 2006;33:1245.
    1. Bensimhon L, Lavergne T, Hugonnet F, Mainardi JL, Latremouille C, Maunoury C, Lepillier A, Le Heuzey JY, Faraggi M. Whole body [(18) F]fluorodeoxyglucose positron emission tomography imaging for the diagnosis of pacemaker or implantable cardioverter defibrillator infection: a preliminary prospective study. Clin Microbiol Infect. 2011;17:836–844.
    1. Ploux S, Riviere A, Amraoui S, Whinnett Z, Barandon L, Lafitte S, Ritter P, Papaioannou G, Clementy J, Jais P, et al. Positron emission tomography in patients with suspected pacing system infections may play a critical role in difficult cases. Heart Rhythm. 2011;8:1478–1481.
    1. Sarrazin JF, Philippon F, Tessier M, Guimond J, Molin F, Champagne J, Nault I, Blier L, Nadeau M, Charbonneau L, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. J Am Coll Cardiol. 2012;59:1616–1625.
    1. Cautela J, Alessandrini S, Cammilleri S, Giorgi R, Richet H, Casalta JP, Habib G, Raoult D, Mundler O, Deharo JC. Diagnostic yield of FDG positron-emission tomography/computed tomography in patients with CEID infection: a pilot study. Europace. 2013;15:252–257.
    1. Ahmed FZ, James J, Cunnington C, Motwani M, Fullwood C, Hooper J, Burns P, Qamruddin A, Al-Bahrani G, Armstrong I, et al. Early diagnosis of cardiac implantable electronic device generator pocket infection using 18F-FDG-PET/CT. Eur Heart J Cardiovasc Imaging. 2015;16:521–530.
    1. Erba PA, Sollini M, Conti U, Bandera F, Tascini C, De Tommasi SM, Zucchelli G, Doria R, Menichetti F, Bongiorni MG, et al. Radiolabeled WBC scintigraphy in the diagnostic workup of patients with suspected device-related infections. JACC Cardiovasc Imaging. 2013;6:1075–1086.
    1. Plank F, Mueller S, Uprimny C, Hangler H, Feuchtner G. Detection of bioprosthetic valve infection by image fusion of (18)fluorodeoxyglucose-positron emission tomography and computed tomography. Interact Cardiovasc Thorac Surg. 2012;14:364–366.
    1. Saby L, Laas O, Habib G, Cammilleri S, Mancini J, Tessonnier L, Casalta JP, Gouriet F, Riberi A, Avierinos JF, et al. Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular 18F-fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol. 2013;61:2374–2382.
    1. Rouzet F, Chequer R, Benali K, Lepage L, Ghodbane W, Duval X, Iung B, Vahanian A, Le Guludec D, Hyafil F. Respective performance of 18F-FDG PET and radiolabeled leukocyte scintigraphy for the diagnosis of prosthetic valve endocarditis. J Nucl Med. 2014;55:1980–1985.
    1. Asmar A, Ozcan C, Diederichsen AC, Thomassen A, Gill S. Clinical impact of 18F-FDG-PET/CT in the extra cardiac work-up of patients with infective endocarditis. Eur Heart J Cardiovasc Imaging. 2014;15:1013–1019.
    1. Erba PA, Conti U, Lazzeri E, Sollini M, Doria R, De Tommasi SM, Bandera F, Tascini C, Menichetti F, Dierckx RA, et al. Added value of 99mTc-HMPAO-labeled leukocyte SPECT/CT in the characterization and management of patients with infectious endocarditis. J Nucl Med. 2012;53:1235–1243.
    1. Hyafil F, Rouzet F, Lepage L, Benali K, Raffoul R, Duval X, Hvass U, Iung B, Nataf P, Lebtahi R, et al. Role of radiolabelled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and inconclusive echocardiography. Eur Heart J Cardiovasc Imaging. 2013;14:586–594.
    1. Schouten LR, Verberne HJ, Bouma BJ, van Eck-Smit BL, Mulder BJ. Surgical glue for repair of the aortic root as a possible explanation for increased F-18 FDG uptake. J Nucl Cardiol. 2008;15:146–147.
    1. Xia T, Alessio AM, De Man B, Manjeshwar R, Asma E, Kinahan PE. Ultra-low dose CT attenuation correction for PET/CT. Phys Med Biol. 2012;57:309–328.
    1. Picano E, Vañó E, Rehani MM, Cuocolo A, Mont L, Bodi V, Bar O, Maccia C, Pierard L, Sicari R, et al. The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology. Eur Heart J. 2014;35:665–672.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit