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 infective endocarditis (IE) in patients with prosthetic valve endocarditis (PVE) and cardiovascular implantable electronic device (CIED) infection. The goal is to demonstrate the ability to interpret FDG-PET acquisitions in these patients and understand the characteristics of the FDG signal.<br /><br />FDG-PET imaging is particularly useful in determining the presence of infection in PVE cases, with high sensitivity and specificity. It can also help identify the origin of the infection and the presence of septic emboli or mycotic aneurysms. The use of FDG-PET imaging in native valve endocarditis (NVE) is more limited due to its lower sensitivity for detecting vegetations.<br /><br />The module includes two clinical cases. In case 1, a patient with a suspicion of PVE is evaluated. FDG-PET imaging shows high signal intensity in the aortic valve region, indicating an active infectious process. The patient undergoes surgery, and active infection is confirmed intra-operatively. In case 2, a patient with CIED infection is evaluated. FDG-PET imaging shows signal along the leads of the CIED, along with pulmonary septic emboli, highly suggestive of infection. The patient undergoes cardiac transplantation, and there is no recurrent infection after one year.<br /><br />The module emphasizes the importance of accurately describing the location, intensity, and pattern of the FDG signal in the report. Whole-body FDG-PET imaging should be carefully analyzed for the presence of septic emboli and alternate diagnoses. False positive results should be considered, such as biological glue or chronic inflammation in cardiac material. Integration of FDG-PET imaging with clinical, biological, and other imaging results is recommended in a multidisciplinary endocarditis team.<br /><br />In conclusion, FDG-PET imaging has demonstrated high sensitivity in detecting perivalvular infection in patients with suspected PVE and CIED infection. It can provide valuable information for diagnosis and treatment decision-making in these patients.

Keywords

FDG-PET imaging

infective endocarditis

prosthetic valve endocarditis

cardiovascular implantable electronic device infection

FDG signal

sensitivity

specificity

septic emboli

mycotic aneurysms

native valve endocarditis