Skip to main content

Advertisement

SpringerLink
Log in

18F-FDG PET/CT for early detection of embolism and metastatic infection in patients with infective endocarditis

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

In the acute setting of endocarditis it is very important to assess both the vegetation itself, as well as potential life-threatening complications, in order to decide whether antibiotic therapy will be sufficient or urgent surgery is indicated. A single whole-body scan investigating inflammatory changes could be very helpful to achieve a swift and efficient assessment.

Methods

In this study we assessed whether 18F-FDG can be used to detect and localize peripheral embolism or distant infection. Twenty-four patients with 25 episodes of endocarditis, enrolled between March 2006 and February 2008, underwent 18F-FDG PET/CT imaging on a dedicated PET/CT scanner.

Results

PET/CT imaging revealed a focus of peripheral embolization and/or metastatic infection in 11 episodes (44%). One episode had a positive PET/CT scan result for both embolism and metastatic infection. PET/CT detected seven positive cases (28%) in which there was no clinical suspicion. Valve involvement of endocarditis was seen only in three patients (12%).

Conclusion

PET/CT may be an important diagnostic tool for tracing peripheral embolism and metastatic infection in the acute setting of infective endocarditis, since a PET/CT scan detected a clinically occult focus in nearly one third of episodes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Haldar SM, O’Gara PT. Infective endocarditis: diagnosis and management. Nat Clin Pract Cardiovasc Med 2006;3(6):310–7.

    Article  PubMed  Google Scholar 

  2. Hoen B. Epidemiology and antibiotic treatment of infective endocarditis: an update. Heart 2006;92(11):1694–700.

    Article  PubMed  CAS  Google Scholar 

  3. Bashore TM, Cabell C, Fowler V Jr. Update on infective endocarditis. Curr Probl Cardiol 2006;31(4):274–352.

    Article  PubMed  Google Scholar 

  4. O’Gara PT. Infective endocarditis 2006: indications for surgery. Trans Am Clin Climatol Assoc 2007;118:187–98.

    PubMed  Google Scholar 

  5. Thuny F, Di Salvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 2005;112:69–75.

    Article  PubMed  Google Scholar 

  6. Hill EE, Herijgers P, Claus P, Vanderschueren S, Peetermans WE, Herregods MC. Clinical and echocardiographic risk factors for embolism and mortality in infective endocarditis. Eur J Clin Microbiol Infect Dis 2008;27:1159–64.

    Article  PubMed  Google Scholar 

  7. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med 2001;345:1318–30.

    Article  PubMed  CAS  Google Scholar 

  8. Hill EE, Herijgers P, Claus P, Vanderschueren S, Herregods MC, Peetermans WE. Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. Eur Heart J 2006;28(2):196–203.

    Article  PubMed  Google Scholar 

  9. Sexton DJ, Spelman D. Current best practices and guidelines. Assessment and management of complications in infective endocarditis. Infect Dis Clin North Am 2002;16(2):507–21.

    Article  PubMed  Google Scholar 

  10. Cone LA, Hirschberg J, Lopez C, Kanna PK, Goldstein EJ, Kazi A, et al. Infective endocarditis associated with spondylodiscitis and frequent secondary epidural abscess. Surg Neurol 2008;69(2):121–5.

    Article  PubMed  Google Scholar 

  11. Metser U, Even-Sapir E. Increased (18)F-fluorodeoxyglucose uptake in benign, nonphysiologic lesions found on whole-body positron emission tomography/computed tomography (PET/CT): accumulated data from four years of experience with PET/CT. Semin Nucl Med 2007;37(3):206–22.

    Article  PubMed  Google Scholar 

  12. Meller J, Sahlmann CO, Scheel AK. 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med 2007;48(1):35–45.

    PubMed  CAS  Google Scholar 

  13. Vos FJ, Bleeker-Rovers CP, Corstens FH, Kullberg BJ, Oyen WJ. FDG-PET for imaging of non-osseous infection and inflammation. Q J Nucl Med Mol Imaging 2006;50(2):121–30.

    PubMed  CAS  Google Scholar 

  14. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, et al. Proposed modifications to the Duke criteria or the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633–8.

    Article  PubMed  CAS  Google Scholar 

  15. LM Baddour, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association—executive summary: endorsed by the Infectious Diseases Society of America. Circulation 2005;111:3167–84.

    Article  Google Scholar 

  16. Moon MR, Stinson EB, Miller DC. Surgical treatment of endocarditis. Prog Cardiovasc Dis 1997;40:239–64.

    Article  PubMed  CAS  Google Scholar 

  17. Facey K, Bradbury I, Laking G, Payne E. Overview of the clinical effectiveness of positron emission tomography imaging in selected cancers. Health Technol Assess 2007;11(44):iii–iv. xi-267.

    PubMed  CAS  Google Scholar 

  18. Reske SN, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, “Onko-PET III”, 21 July and 19 September 2000. Eur J Nucl Med 2001;28(11):1707–23.

    Article  PubMed  CAS  Google Scholar 

  19. Bomanji JB, Costa DC, Ell PJ. Clinical role of positron emission tomography in oncology. Lancet Oncol 2001;2(3):157–64.

    Article  PubMed  CAS  Google Scholar 

  20. Reeps C, Essler M, Pelisek J, Seidl S, Eckstein HH, Krause BJ. Increased 18F-fluorodeoxyglucose uptake in abdominal aortic aneurysms in positron emission/computed tomography is associated with inflammation, aortic wall instability, and acute symptoms. J Vasc Surg 2008;48:417–23.

    Article  PubMed  Google Scholar 

  21. Hautzel H, Sander O, Heinzel A, Schneider M, Müller HW. Assessment of large-vessel involvement in giant cell arteritis with 18F-FDG PET: introducing an ROC-analysis-based cutoff ratio. J Nucl Med 2008;49:1107–13.

    Article  PubMed  Google Scholar 

  22. Walker RC, Jones-Jackson LB, Martin W, Habibian MR, Delbeke D. New imaging tools for the diagnosis of infection. Future Microbiol 2007;2(5):527–54.

    Article  PubMed  CAS  Google Scholar 

  23. De Winter F, Vogelaers D, Gemmel F, Dierckx RA. Promising role of 18-F-fluoro-D-deoxyglucose positron emission tomography in clinical infectious disease. Eur J Clin Microbiol Infect Dis 2002;21:247–57.

    Article  PubMed  CAS  Google Scholar 

  24. Bird PA, Shnier R, Edmonds JP. Questioning the sensitivity of magnetic resonance imaging in early septic spondylodiscitis. J Clin Rheumatol 2001;7(3):184–7.

    Article  PubMed  CAS  Google Scholar 

  25. Fabri J Jr, Issa VS, Pomerantzeff PM, Grinberg M, Barretto AC, Mansur AJ. Time-related distribution, risk factors and prognostic influence of embolism in patients with left-sided infective endocarditis. Int J Cardiol 2006;110(3):334–9.

    Article  PubMed  Google Scholar 

  26. Schünemann S, Werner GS, Schulz R, Bitsch A, Prange HW, Kreuzer H. Embolic complications in bacterial endocarditis. Z Kardiol 1997;86(12):1017–25. German.

    Article  PubMed  Google Scholar 

  27. Bockisch A, Beyer T, Antoch G, Freudenberg LS, Kühl H, Debatin JF, et al. Positron emission tomography/computed tomography—imaging protocols, artifacts, and pitfalls. Mol Imaging Biol 2004;6(4):188–99.

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Jelle Van Riet, Olivier Gheysens & Luc Mortelmans

  2. Department of Cardiology, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Evelyn E. Hill & Marie-Christine Herregods

  3. Department of Radiology, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Steven Dymarkowski

  4. Department of Cardiac Surgery, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Paul Herijgers

  5. Department of Internal Medicine, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Willy E. Peetermans

Authors
  1. Jelle Van Riet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Evelyn E. Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olivier Gheysens
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven Dymarkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marie-Christine Herregods
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul Herijgers
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Willy E. Peetermans
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luc Mortelmans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luc Mortelmans.

Additional information

The work was performed in the Department of Nuclear Medicine, University Hospital KU Leuven, Herestraat 49, 3000 Leuven, Belgium. All authors have seen and approved the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Van Riet, J., Hill, E.E., Gheysens, O. et al. 18F-FDG PET/CT for early detection of embolism and metastatic infection in patients with infective endocarditis. Eur J Nucl Med Mol Imaging 37, 1189–1197 (2010). https://doi.org/10.1007/s00259-010-1380-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-010-1380-x

Keywords

Search

Navigation