Module 21: Case Review – Non-Perfusion Imaging - Infection and Inflammation-Non-Perfusion Imaging

Non-Perfusion Imaging - Infection and Inflammation (Slides)

Pdf Summary

This module focuses on the use of FDG-PET imaging in the diagnosis of infection and inflammation, specifically in cases of infective endocarditis (IE) and cardiovascular implantable electronic device (CIED) infection. The goal of this module is to demonstrate the ability to interpret FDG-PET scans in patients suspected of having endocarditis and to identify characteristics of false positive studies. <br /><br />The module discusses the increasing use of prosthetic valves and cardiac electronic devices, which can be associated with infectious syndromes or fever of unknown origin. The diagnosis of infection in these patients can be challenging, and FDG-PET imaging can play a role in confirming infection and identifying its origin. The module includes case studies that highlight the benefits and limitations of using FDG-PET imaging in these scenarios. <br /><br />In the case of prosthetic valve endocarditis (PVE), FDG-PET imaging has been shown to have high sensitivity and specificity. It can help detect infective foci, identify the origin of the infection, and differentiate between septic and thrombotic emboli. However, its sensitivity is lower in cases of native valve endocarditis (NVE). False positive and false negative results are also possible, and careful interpretation of the FDG signal is necessary.<br /><br />For CIED infection, FDG-PET imaging has been found to have high diagnostic accuracy, particularly for detecting pocket infection. It can also help identify pulmonary septic emboli. However, its sensitivity for lead infection is lower, especially after antibiotics have been initiated.<br /><br />The module emphasizes the importance of integrating the analysis of FDG-PET imaging with clinical, biological, and other imaging results, ideally within a multidisciplinary endocarditis team. The location, intensity, and pattern of the FDG signal should be described precisely in the report, and whole-body imaging should be carefully analyzed to search for septic emboli, portal of entry, and alternate infective or inflammatory causes. False positive causes should be considered, and the limitations of FDG-PET imaging should be taken into account when interpreting the results.<br /><br />In summary, FDG-PET imaging can be a valuable tool in the diagnosis of infection and inflammation in cases of endocarditis and CIED infection. It provides high sensitivity in detecting perivalvular infection in PVE cases and can be useful in identifying pocket and lead infection in CIED cases. However, careful interpretation and integration with other clinical and imaging findings are necessary.

Keywords

FDG-PET imaging

infection

inflammation

diagnosis

endocarditis

CIED infection

prosthetic valves

lead infection

septic emboli

multidisciplinary team