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

Endocarditis

2016 ◽  
Author(s):  
Gilbert Habib ◽  
Franck Thuny ◽  
Guy Van Camp ◽  
Simon Matskeplishvili
Keyword(s):  
Infective Endocarditis ◽  
Task Force ◽  
Imaging Techniques ◽  
Three Dimensional ◽  
Transoesophageal Echocardiography ◽  
Long Term Prognosis ◽  
Severity Of The Disease ◽  
European Society Of Cardiology ◽  
Embolic Risk

Echocardiography plays a key role in the assessment of infective endocarditis (IE). It is useful both for the diagnosis of endocarditis, the assessment of the severity of the disease, the prediction of short-term and long-term prognosis, the prediction of embolic risk, the management of the complications of endocarditis, and the follow-up of patients under specific antibiotic therapy. The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology and the ‘Recommendations for the practice of echocardiography in infective endocarditis’ of the European Association for Echocardiography have underlined the value and limitations of echocardiography in IE, and gave clear recommendations for the optimal use of both transthoracic and transoesophageal echocardiography in IE. New data in the field of echocardiography in IE includes more extensive use of three-dimensional transoesophageal echocardiography, inclusion of other imaging techniques, and new important publications in the field of the prediction of embolic risk by echocardiography.

Infective endocarditis

2011 ◽  
Author(s):  
Gilbert Habib ◽  
Franck Thuny
Keyword(s):  
Infective Endocarditis ◽  
European Association ◽  
Transoesophageal Echocardiography ◽  
Short Term ◽  
Long Term Prognosis ◽  
Severity Of The Disease ◽  
European Society Of Cardiology ◽  
Embolic Risk

Echocardiography plays a key role in the assessment of infective endocarditis. It is useful for the diagnosis of endocarditis, the assessment of severity of the disease, the prediction of short-term and long-term prognosis, the prediction of embolic risk, the management of the complications of endocarditis, and the follow-up of patients under specific antibiotic therapy.The ‘Guidelines on the prevention, diagnosis, and treatment of infective endocarditis’ of the European Society of Cardiology and the ‘Recommendations for the practice of echocardiography in infective endocarditis’ of the European Association for Echocardiography recently underlined the value and limitations of echocardiography in infective endocarditis, and gave clear recommendations for the optimal use of both transthoracic echocardiography and transoesophageal echocardiography in infective endocarditis.

scholarly journals 18F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization

2021 ◽  
Vol 23 (9) ◽  
Author(s):  
D. ten Hove ◽  
R.H.J.A. Slart ◽  
B. Sinha ◽  
A.W.J.M. Glaudemans ◽  
R.P.J. Budde
Keyword(s):  
Infective Endocarditis ◽  
Fdg Pet ◽  
Prosthetic Valve Endocarditis ◽  
Cardiac Device ◽  
Native Valve ◽  
Prosthetic Valves ◽  
Cardiac Devices ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Disseminated Disease

Abstract Purpose of Review Additional imaging modalities, such as FDG-PET/CT, have been included into the workup for patients with suspected infective endocarditis, according to major international guidelines published in 2015. The purpose of this review is to give an overview of FDG-PET/CT indications and standardized approaches in the setting of suspected infective endocarditis. Recent Findings There are two main indications for performing FDG-PET/CT in patients with suspected infective endocarditis: (i) detecting intracardiac infections and (ii) detection of (clinically silent) disseminated infectious disease. The diagnostic performance of FDG-PET/CT for intracardiac lesions depends on the presence of native valves, prosthetic valves, or implanted cardiac devices, with a sensitivity that is poor for native valve endocarditis and cardiac device-related lead infections, but much better for prosthetic valve endocarditis and cardiac device-related pocket infections. Specificity is high for all these indications. The detection of disseminated disease may also help establish the diagnosis and/or impact patient management. Summary Based on current evidence, FDG-PET/CT should be considered for detection of disseminated disease in suspected endocarditis. Absence of intracardiac lesions on FDG-PET/CT cannot rule out native valve endocarditis, but positive findings strongly support the diagnosis. For prosthetic valve endocarditis, standard use of FDG-PET/CT is recommended because of its high sensitivity and specificity. For implanted cardiac devices, FDG-PET/CT is also recommended, but should be evaluated with careful attention to clinical context, because its sensitivity is high for pocket infections, but low for lead infections. In patients with prosthetic valves with or without additional aortic prosthesis, combination with CTA should be considered. Optimal timing of FDG-PET/CT is important, both during clinical workup and technically (i.e., post tracer injection). In addition, procedural standardization is key and encompasses patient preparation, scan acquisition, reconstruction, subsequent analysis, and clinical interpretation. The recommendations discussed here will hopefully contribute to improved standardization and enhanced performance of FDG-PET/CT in the clinical management of patients with suspected infective 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.

Abstract 12920: The Value of 18 FDG PET/CT in the Diagnostic Work-Up of Patients With Possible Infective Endocarditis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fabio Chirillo ◽  
Franco Boccaletto ◽  
Paola Pantano ◽  
Alessandro De Leo ◽  
Marta Possamai ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Clinical Judgment ◽  
Predictive Value ◽  
Fdg Pet ◽  
Blood Cultures ◽  
Fdg Uptake ◽  
Duke Criteria ◽  
Pet Ct ◽  
Fdg Pet Ct

The diagnosis of infective endocarditis (IE) is sometimes difficult when there are discrepancies between blood cultures, transesophageal echocardiography (TEE) and clinical judgment. The aim of this study was to assess the incremental diagnostic value of 18 F-FDG-PET/CT in 45 consecutive patients (73% male, mean age 61 ± 26 years) with suspected IE and inconclusive tests at admission. In 28 patients (19 with a cardiac valvular (15) or nonvalvular (4) device) with blood cultures positive for germs typically involved in IE the initial TEE was negative or inconclusive. In 10 patients presenting with fever TEE identified cardiac lesion possibly related to IE (ruptured mitral chordae, thickened valve leaflet, thickened prosthetic annulus), but blood cultures were persistently negative. Finally, 7 patients had metastatic or embolic lesions and a predisposing cardiac condition, but TEE was negative. When previous unknown lesions detected by PET/CT were confirmed by succeeding examinations, they were considered true positives. When PET/CT was negative, it was compared with the final diagnosis that was defined according to the modified Duke criteria determined during a 6-month follow-up. Thirty patients had definite IE at the end of the follow-up, 3 had possible IE, and in 12 patients the diagnosis was rejected. Twenty-seven patients (60%) exhibited abnormal FDG uptake around the cardiac valves, and 12 (27%) had extracardiac accumulation. In 5 patients the initial negative TEE became positive a mean 5 ±7 days after PET/CT had been performed The sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT were as follows (95% confidence interval): 87% (68% to 95%), 67% (38% to 87%), 84% (65% to 94%), and 71% (42% to 92%), respectively. Adding abnormal FDG uptake as a new major criterion significantly increased the sensitivity of the modified Duke criteria at admission (68% [53% to 82%] vs. 96% [88% to 99%], p = 0.01). This result was due to a significant reduction (p < 0.001) in the number of possible IE cases. In conclusion PET/CT increases the diagnostic accuracy for IE in the subset of patients with possible IE and may help to manage a challenging situation.

333018F-Fluorodeoxyglucose Positron Emission Tomography Computed Tomography (PET/CT) for the diagnosis of prosthetic valve infective endocarditis (PVIE): a prospective multicenter study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Philip ◽  
L Tessonnier ◽  
J Mancini ◽  
J L Mainardi ◽  
D Lussato ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Predictive Value ◽  
Fdg Pet ◽  
Prosthetic Valve ◽  
Cardiac Uptake ◽  
Pet Ct ◽  
Major Criterion ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Background and objectives 18F-FDG PET/CT has recently been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines, but the value of this new diagnostic algorithm has never been prospectively assessed. Purposes 1. Primary objective: to assess the value of the new ESC criteria including 18F-FDG PET/CT in prosthetic valve infective endocarditis (PVIE). 2. Secondary objectives: to determine the reproducibility of 18F-FDG PET/CT; to assess its ability to predict embolic events. Methods Between 2014 and 2017, 175 patients with suspected PVIE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable or not feasible PET/CT,115 patients were finally included in the analysis, including 91 definite IE and 24 rejected IE, as defined by an expert Consensus of Endocarditis Team after 3-month follow-up as Gold Standard Nuclear data were blindly analyzed by two independent nuclear medicine physicians. Patients follow-up was scheduled at one and three months after hospitalization Results Significant cardiac uptake by PET/CT (major criterion) was observed in 67 among 91 patients with definite PVIE and 6 patients with rejected IE (sensitivity 73.6%, specificity 75%, positive predictive value 91%, negative predictive value 42%). Considering cardiac uptake as a major criterion, the ESC 2015 classification increased the sensitivity of Duke criteria from 57 to 84% (p<0.001) but decreased its specificity from 84 to 70% (p<0.001). Intraobserver reproducibility of cardiac uptake evaluation was good (kappa = 0.84) but inter observer reproductibility was less satisfactory (kappa = 0.63). Embolic events occurred in 31 patients (27%) and were correlated with vegetation size by ECHO (p<0.001), Staphylococcus infection (p=0.003), and PET/CT cardiac uptake (p=0.02). Conclusion 1. the value of PET CT and ESC criteria is confirmed and may allow earlier diagnosis of PVIE 2. PET CT is associated with an increased risk of false positive results probably related to the technical improvements 3. Reproducibility of nuclear measurements seems unsatisfactory, justifying efforts to standardize PET studies interpretation 4. Our study describes for the first time a positive correlation between a positive PET/Ct and occurrence of embolic events, warranting additional studies.

scholarly journals Long-term Outcome of Patients With Nonoperated Prosthetic Valve Infective Endocarditis: Is Relapse the Main Issue?

2019 ◽  
Vol 71 (5) ◽  
pp. 1316-1319 ◽  
Author(s):  
Raphaël Lecomte ◽  
Jean-Baptiste Laine ◽  
Nahéma Issa ◽  
Matthieu Revest ◽  
Benjamin Gaborit ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mortality Rate ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Main Issue ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Risk Of Relapse

Abstract In nonoperated prosthetic valve endocarditis (PVE), long-term outcome is largely unknown. We report the follow-up of 129 nonoperated patients with PVE alive at discharge. At 1 year, the mortality rate was 24%; relapses and reinfection were rare (5% each). Enterococcal PVE was associated with a higher risk of relapse.

scholarly journals Novel insights into the polycythemia–paraganglioma–somatostatinoma syndrome

2016 ◽  
Vol 23 (12) ◽  
pp. 899-908 ◽  
Author(s):  
Roland Därr ◽  
Joan Nambuba ◽  
Jaydira Del Rivero ◽  
Ingo Janssen ◽  
Maria Merino ◽  
...  
Keyword(s):  
Gallbladder Disease ◽  
Hypoxia Inducible Factor ◽  
Somatic Mosaicism ◽  
Clinical Aspects ◽  
Von Hippel Lindau ◽  
Pet Ct ◽  
Von Hippel Lindau Disease ◽  
Long Term Prognosis

Worldwide, the syndromes of paraganglioma (PGL), somatostatinoma (SOM) and early childhood polycythemia are described in only a few patients with somatic mutations in the hypoxia-inducible factor 2 alpha (HIF2A). This study provides detailed information about the clinical aspects and course of 7 patients with this syndrome and brings into perspective these experiences with the pertinent literature. Six females and one male presented at a median age of 28 years (range 11–46). Two were found to have HIF2A somatic mosaicism. No relatives were affected. All patients were diagnosed with polycythemia before age 8 and before PGL/SOM developed. PGLs were found at a median age of 17 years (range 8–38) and SOMs at 29 years (range 22–38). PGLs were multiple, recurrent and metastatic in 100, 100 and 29% of all cases, and SOMs in 40, 40 and 60%, respectively. All PGLs were primarily norepinephrine-producing. All patients had abnormal ophthalmologic findings and those with SOMs had gallbladder disease. Computed tomography (CT) and magnetic resonance imaging revealed cystic lesions at multiple sites and hemangiomas in 4 patients (57%), previously thought to be pathognomonic for von Hippel–Lindau disease. The most accurate radiopharmaceutical to detect PGL appeared to be [18F]-fluorodihydroxyphenylalanine ([18F]-FDOPA). Therefore, [18F]-FDOPA PET/CT, not [68Ga]-(DOTA)-[Tyr3]-octreotate ([68Ga]-DOTATATE) PET/CT is recommended for tumor localization and aftercare in this syndrome. The long-term prognosis of the syndrome is unknown. However, to date no deaths occurred after 6 years follow-up. Physicians should be aware of this unique syndrome and its diagnostic and therapeutic challenges.

Imaging techniques used in the diagnosis, staging, and follow-up of patients with myeloma

2005 ◽  
Vol 46 (7) ◽  
pp. 716-724 ◽  
Author(s):  
M. E. Mulligan
Keyword(s):  
Imaging Techniques ◽  
Staging System ◽  
Review Article ◽  
Imaging Modalities ◽  
Resonance Imaging ◽  
Advanced Imaging ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Initial Staging

Radiologists play a central role in the diagnosis, initial staging, follow-up, and restaging of patients with myeloma. This review article attempts to familiarize the reader with all the various types of myeloma, their imaging appearances and useful imaging strategies. The staging system for myeloma patients has been updated and now includes findings from advanced imaging modalities. Radiologists have a vast array of imaging modalities at their disposal to aid them in diagnosis, staging, and follow-up. Currently, conventional radiographic skeletal surveys, magnetic resonance imaging, and F-18 FDG PET/CT examinations are the most useful instruments.

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