P3666Spondylitis: a frequent and severe complication of infective endocarditis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Carbone ◽  
B Mouhat ◽  
A Lieu ◽  
F Santelli ◽  
Y Bohbot ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Lumbar Vertebrae ◽  
Primary Objective ◽  
Severe Complication ◽  
Therapeutic Implications ◽  
Streptococcus Gallolyticus ◽  
Contrast Enhanced ◽  
Pet Ct

Abstract Background Spondylodiscitis (SP) is a rare, but severe complication of infective endocarditis (IE). The incidence, clinical features and prognosis of SP in IE are unknown. Purpose The primary objective of our study was to assess the incidence, epidemiology, clinical presentation, prognosis, and therapeutic implications of SP in patient with IE. The secondary objectives were to assess factors associated with occurrence of spondylitis and to assess the value of imaging techniques. Methods In a French bi-center prospective study of patients who presented in our endocarditis reference centers with a diagnosis of definite IE from 1990 to 2018 (n=1755), 150 (8.5%) presented with SP. Clinical, epidemiological, microbiological, and prognostic variables were prospectively recorded and compared between patients with (n=150) and without (n=1605) SP. Results Patients with SP were older (mean age 69.7±18 vs 66.2±14; p=0.004), had more arterial hypertension (48% vs 34,5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without SP. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L3-L4. Neurological symptoms were observed in 59% of patients. Enterococci et Gallolyticus streptococci were more frequent (24% vs 12% and 24% vs 11%; p<0,001, respectively) in the SP group. Observed sensitivities of full spine contrast-enhanced MRI and CT were 95% and 89%, respectively. PET/CT had a great power to differentiate infective to degenerative vertebral processes, and to find embolic foci with a sensitivity of 90%. Clinical outcome did not differ between patients with or without SP, including similar in-hospital mortality (16% vs 13,5%, p=0.38). Conclusions We describe the largest ever reported series of patients with spondylodiscitis complicating IE. Spondylodiscitis is a more frequent complication of IE than previously reported (8.5% of IE), is observed in older hypertensive patients with Enterococcal or Streptococcus gallolyticus IE and has a similar prognosis than other forms of IE. Since SP is associated with prolonged antibiotic therapy and may need specific surgical therapy, multimodality imaging including MRI, CT, and PET/CT should be used for early diagnosis of this IE complication.

Spondylodiscitis complicating infective endocarditis

Heart ◽  
2020 ◽  
Vol 106 (24) ◽  
pp. 1914-1918 ◽  
Author(s):  
Andreina Carbone ◽  
Audrey Lieu ◽  
Basile Mouhat ◽  
Francesco Santelli ◽  
Mary Philip ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Multimodality Imaging ◽  
Lumbar Vertebrae ◽  
Primary Objective ◽  
Prognostic Variables ◽  
Factors Associated ◽  
Streptococcus Gallolyticus ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Fdg Pet Ct

ObjectiveThe primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS.MethodsProspective case–control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded.ResultsPatients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without PS. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L4–L5. Neurological symptoms were observed in 59% of patients. Enterococci and Streptococcus gallolyticus were more frequent (24% vs 12% and 24% vs 11%; p<0001, respectively) in the PS group. The diagnosis of PS was based on contrast-enhanced MRI in 92 patients, bone CT in 88 patients and 18F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS.ConclusionsPS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or S. gallolyticus IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.

scholarly journals Nuclear Imaging in Infective Endocarditis

2021 ◽  
Vol 15 (1) ◽  
pp. 14
Author(s):  
Nidaa Mikail ◽  
Fabien Hyafil
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Fdg Pet ◽  
Imaging Techniques ◽  
Nuclear Imaging ◽  
Emission Tomography ◽  
Cardiac Devices ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Infective endocarditis (IE) is a life-threatening disease with stable prevalence despite prophylactic, diagnostic, and therapeutic advances. In parallel to the growing number of cardiac devices implanted, the number of patients developing IE on prosthetic valves and cardiac implanted electronic device (CIED) is increasing at a rapid pace. The diagnosis of IE is particularly challenging, and currently relies on the Duke-Li modified classification, which include clinical, microbiological, and imaging criteria. While echocardiography remains the first line imaging technique, especially in native valve endocarditis, the incremental value of two nuclear imaging techniques, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) and white blood cells single photon emission tomography with computed tomography (WBC-SPECT), has emerged for the management of prosthetic valve and CIED IE. In this review, we will summarize the procedures for image acquisition, discuss the role of 18F-FDG-PET/CT and WBC-SPECT imaging in different clinical situations of IE, and review the respective diagnostic performance of these nuclear imaging techniques and their integration into the diagnostic algorithm for patients with a suspicion of IE.

Endocarditis

2015 ◽  
pp. 230-244
Author(s):  
Gilbert Habib ◽  
Franck Thuny
Keyword(s):  
Infective Endocarditis ◽  
Imaging Techniques ◽  
Prosthetic Valve Endocarditis ◽  
Transoesophageal Echocardiography ◽  
Pet Ct ◽  
Long Term Prognosis ◽  
Severity Of The Disease ◽  
Fdg Pet Ct

Imaging plays a key role in the assessment of infective endocarditis. Echocardiography, particularly transoesophageal echocardiography, gives useful information concerning the diagnosis of infective endocarditis, the assessment of the severity of the disease, the prediction of short-term and long-term prognosis, and the follow-up of patients under specific antibiotic therapy. Other imaging techniques, including magnetic resonance imaging, Computed tomography (CT) scan, and invasive angiography, are of limited value for the diagnosis of infective endocarditis, but are useful for the diagnosis and management of its complications. FDG PET/CT imaging seems the most promising new imaging technique, particularly for the diagnosis of prosthetic valve endocarditis

Comparative Study of Various Nuclear Medicine Imaging Technique - A Review

2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Beena Ullala Mata B N ◽  
Anup Kumar Pal ◽  
Hrithik Sivadasan ◽  
Himanshu Mishra
Keyword(s):  
Nuclear Medicine ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Medical Specialty ◽  
Pharmacological Action ◽  
Individual Member ◽  
Nuclear Medicine Imaging ◽  
Pet Ct ◽  
Nuclear Medicine Instrumentation ◽  
The Impact

Nuclear Medicine is a medical specialty that allows modern diagnostics and treatments using radiopharmaceuticals original radiotracers (drugs linked to a radioactive isotope). The radiopharmaceuticals are considered a special group of drugs and thus their preparation and use are regulated by a set of policies that have been adopted by individual member countries. The radiopharmaceuticals used in diagnostic examinations are administered in very small doses. So, in general, they have no pharmacological action, side effects or serious adverse reactions. The most serious issue with their use is the potential for diagnostic mistakes due to changes in their biodistribution. The appearance and development of new radiopharmaceuticals in both the diagnostic and therapeutic domains, as well as the impact of new multimodality imaging techniques, are all having a significant impact on nuclear medicine (SPECT-CT, PET-CT, PET-MRI, etc.). It is crucial to understand the techniques limitations, radiopharmaceutical distribution and potential physiological changes, radiological contrast contraindications and bad responses, and the possibility of both interfering. The process of generating radiopharmaceuticals is introduced and relevant interactions of radiation with matter are discussed. Diagnostic nuclear medicine instrumentation is explained, and future trends in nuclear medicine imaging technology are forecasted.

scholarly journals Multimodality Imaging in the Diagnosis of Prosthetic Valve Endocarditis: A Brief Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Maxwell D. Eder ◽  
Krishna Upadhyaya ◽  
Jakob Park ◽  
Matthew Ringer ◽  
Maricar Malinis ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Prosthetic Valve Endocarditis ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Duke Criteria ◽  
Positron Emission ◽  
Leukocyte Scintigraphy

Infective endocarditis is a common and treatable condition that carries a high mortality rate. Currently the workup of infective endocarditis relies on the integration of clinical, microbiological and echocardiographic data through the use of the modified Duke criteria (MDC). However, in cases of prosthetic valve endocarditis (PVE) echocardiography can be normal or non-diagnostic in a high proportion of cases leading to decreased sensitivity for the MDC. Evolving multimodality imaging techniques including leukocyte scintigraphy (white blood cell imaging), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), multidetector computed tomographic angiography (MDCTA), and cardiac magnetic resonance imaging (CMRI) may each augment the standard workup of PVE and increase diagnostic accuracy. While further studies are necessary to clarify the ideal role for each of these imaging techniques, nevertheless, these modalities hold promise in determining the diagnosis, prognosis, and care of PVE. We start by presenting a clinical vignette, then evidence supporting various modality strategies, balanced by limitations, and review of formal guidelines, when available. The article ends with the authors' summary of future directions and case conclusion.

Comparative Study of Various Nuclear Medicine Imaging Technique - A Review

2021 ◽  
Vol 6 (3) ◽  
Author(s):  
Beena Ullala Mata B N ◽  
Anup Kumar Pal ◽  
Hrithik Sivadasan ◽  
Himanshu Mishra
Keyword(s):  
Nuclear Medicine ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Medical Specialty ◽  
Pharmacological Action ◽  
Individual Member ◽  
Nuclear Medicine Imaging ◽  
Pet Ct ◽  
Nuclear Medicine Instrumentation ◽  
The Impact

Nuclear Medicine is a medical specialty that allows modern diagnostics and treatments using radiopharmaceuticals original radiotracers (drugs linked to a radioactive isotope). The radiopharmaceuticals are considered a special group of drugs and thus their preparation and use are regulated by a set of policies that have been adopted by individual member countries. The radiopharmaceuticals used in diagnostic examinations are administered in very small doses. So, in general, they have no pharmacological action, side effects or serious adverse reactions. The most serious issue with their use is the potential for diagnostic mistakes due to changes in their biodistribution. The appearance and development of new radiopharmaceuticals in both the diagnostic and therapeutic domains, as well as the impact of new multimodality imaging techniques, are all having a significant impact on nuclear medicine (SPECT-CT, PET-CT, PET-MRI, etc.). It is crucial to understand the techniques limitations, radiopharmaceutical distribution and potential physiological changes, radiological contrast contraindications and bad responses, and the possibility of both interfering. The process of generating radiopharmaceuticals is introduced and relevant interactions of radiation with matter are discussed. Diagnostic nuclear medicine instrumentation is explained, and future trends in nuclear medicine imaging technology are forecasted.

Peritoneal malignancy: anatomy, pathophysiology and an update on modern day imaging

2021 ◽  
Author(s):  
Jack W Power ◽  
Philip J Dempsey ◽  
Andrew Yates ◽  
Helen Fenlon ◽  
Jurgen Mulsow ◽  
...  
Keyword(s):  
Disease Burden ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Disease Process ◽  
Treatment Regimens ◽  
Pet Ct ◽  
Anatomic Basis ◽  
Pre Treatment ◽  
Direct Inspection ◽  
Peritoneal Malignancy

With increasing subspecialized experience in radical cytoreductive surgery and intra abdominal chemotherapy for peritoneal malignancy, outcomes have improved significantly in selected patients. The surgery and the treatment regimens are radical and therefore correct patient selection is critical. The radiologist plays a central role in this process by estimating, as precisely as possible, the pre-treatment disease burden. Because of the nature of the disease process, accurate staging is not an easy task. Tumour deposits may be very small and in locations where they are very difficult to detect. It must be acknowledged that no form of modern day imaging has the capability of detecting the smallest peritoneal nodules which may only be visible to direct inspection or histopathological evaluation. Nonetheless, it behoves the radiologist to be as exact and precise as possible in the reporting of this disease process. This is both to select patients who are likely to benefit from radical treatment, and just as importantly, to identify patients who are unlikely to achieve adequate cytoreductive outcomes. In this review, we outline the patterns of spread of disease and the anatomic basis for this, as well as the essential aspects of reporting abdominal studies in this patient group. We provide an evidence-based update on the relative strengths and limitations of our available multimodality imaging techniques namely CT, MRI and PET/CT.

scholarly journals Aortic valve stenosis—multimodality assessment with PET/CT and PET/MRI

2020 ◽  
Vol 93 (1113) ◽  
pp. 20190688 ◽  
Author(s):  
Evangelos Tzolos ◽  
Jack PM Andrews ◽  
Marc R. Dweck
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Transoesophageal Echocardiography ◽  
Developed Countries ◽  
Valve Disease ◽  
Heart Valve Disease ◽  
Ageing Population ◽  
Pet Ct

Aortic valve disease is the most common form of heart valve disease in developed countries and a growing healthcare burden with an ageing population. Transthoracic and transoesophageal echocardiography remains central to the diagnosis and surveillance of patients with aortic stenosis, providing gold standard assessments of valve haemodynamics and myocardial performance. However, other multimodality imaging techniques are being explored for the assessment of aortic stenosis, including combined PET/CT and PET/MR. Both approaches provide unique information with respect to disease activity in the valve alongside more conventional anatomic assessments of the valve and myocardium in this condition. This review investigates the emerging use of PET/CT and PET/MR to assess patients with aortic stenosis, examining how the complementary data provided by each modality may be used for research applications and potentially in future clinical practice.

Restaging of patients with lymphoma

2008 ◽  
Vol 47 (01) ◽  
pp. 37-42 ◽  
Author(s):  
T. Pfluger ◽  
V. Schneider ◽  
M. Hacker ◽  
N. Bröckel ◽  
D. Morhard ◽  
...  
Keyword(s):  
Low Dose ◽  
Non Hodgkin Lymphoma ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Significant Difference ◽  
18F Fdg ◽  
Sensitivity Specificity ◽  
Fdg Pet Ct

SummaryAim: Assessment of the clinical benefit of i.v. contrast enhanced diagnostic CT (CE-CT) compared to low dose CT with 20 mAs (LD-CT) without contrast medium in combined [18F]-FDG PET/CT examinations in restaging of patients with lymphoma. Patients, methods: 45 patients with non-Hodgkin lymphoma (n = 35) and Hodgkin's disease (n = 10) were included into this study. PET, LD-CT and CECT were analyzed separately as well as side-by-side. Lymphoma involvement was evaluated separately for seven regions. Indeterminate diagnoses were accepted whenever there was a discrepancy between PET and CT findings. Results for combined reading were calculated by rating indeterminate diagnoses according the suggestions of either CT or PET. Each patient had a clinical follow-up evaluation for >6 months. Results: Region-based evaluation suggested a sensitivity/specificity of 66/93% for LD-CT, 87%/91% for CE-CT, 95%/96% for PET, 94%/99% for PET/LD-CT and 96%/99% for PET/CE-CT. The data for PET/CT were obtained by rating indeterminate results according to the suggestions of PET, which turned out to be superior to CT. Lymphoma staging was changed in two patients using PET/ CE-CT as compared to PET/LD-CT. Conclusion: Overall, there was no significant difference between PET/LD-CT and PET/CE-CT. However, PET/CE-CT yielded a more precise lesion delineation than PET/LD-CT. This was due to the improved image quality of CE-CT and might lead to a more accurate investigation of lymphoma.

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