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Mª José García VellosoServicio de Medicina Nuclear

Clínica Universidad de NavarraSpain

Hybrid imaging of cardiovascular infections

Sarajevo (Bosnia & Hercegovina)Thursday, June 19 2014

10:20-11:00 a.m

Millar BC. International J Cardiol. 2013

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APPLICATION of FDG PET/CT:• Infective endocarditis• Vascular graft infection• CIED infection• Emboli• Metastatic infection• Monitoring of therapeutic

treatment of IE

Millar BC. International J Cardiol. 2013

Sarrazin JF. JAAC 2013

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Sarrazin JF. JAAC 2013

Univ. Osaka - Fukuchi K, Journal of vascular surgery 2005

Detection of aortic graft infection by FDG-PET: Comparison with CT findings

CT FDG-PET Prospective, 33 patients

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Univ. Haifa - Keidar Z. J Nucl Med 2007

Femoropopliteal bypass graftProspective, 39 patients

Infected surgical wound

Univ. Haifa - Keidar Z. J Nucl Med 2007

Prospective, 39 patients

S:93% - Sp: 91% - PPV:88% - NPV:96%

Femoropopliteal bypass graft

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47-year-old male. Dissection of the thoracic aorta. Aortic valve replacement (metal prosthesis) and implementation of two tubes of aortic Dacron.

Candidiasis

47-year-old male. Dissection of the thoracic aorta. Aortic valve replacement (metal prosthesis) and implementation of two tubes of aortic Dacron.

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Univ. Leuven - Gheysens O. Eur J Nucl Med Mol Imaging 2012

Univ. Leuven - Van Riet J. Eur J Nucl Med Mol Imaging 2010

In 11/25 (44%) of casses, FDG detected a clinically occult focus.

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Univ. Bologna - Bonfiglioli R. Eur J Nucl Med Mol Imaging 2013

SpondylodiscitisAortic prosthetic valve

Univ. Bologna - Bonfiglioli R. Eur J Nucl Med Mol Imaging 2013

Sternal Osteomyelitis Osteochondritis with an abscess

17/71 (24%) of casses, leading to changes in therapeutic management.

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Univ. Karolinska - Wassélius J. J Nucl Med 2008

Retrospective, 16 patients

Leukocytescintigraphy

FDG uptake in 15/16 vascular grafts without graft infection

Univ. Karolinska - Wassélius J. J Nucl Med 2008

Retrospective, 16 patients

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Univ. Praga - Spacek M. Eur J Nucl Med Mol Imaging 2009

Prospective, 76 patients: focal FDG uptake and irregular graft boundary - Acc>95%

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Univ. Groningen - Bruggink JLM. Eur J Vasc Endovasc Surg 2010

CT FDG PET/CTFDG PET

Retrospective, 25 patients, 15 had a proven infection – S:93% – Sp:70%

Visual scale:1. Background2. Low3. Moderate4. High

71-year-old manFeverBacteriemia S. aureusFDG PET/CT: mitral valve

65-year-old man Fevergroup B Streptococcus bacteraemiaFDG PET/CT: aortic valve

Standard patient preparation : Sensitivity: 39% Specificity=93%

Univ. Radboud - Kouijzer IJ. Eur J Nucl Med Mol Imaging 2013

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FDG PET/CT: VARIABLE CARDIAC UPTAKE

Standard patient preparation

Preadministration of unfractionated heparin: 45 min before F18-FDG injection (50 IU/kg)

Eur J Nucl Med Mol Imaging 2011;38: 1773-1783.

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Preadministration of unfractionated heparin: 45 min before F18-FDG injection (50 IU/kg)

Eur J Nucl Med Mol Imaging 2011;38: 1773-1783.

Preadministration of unfractionated heparin: 45 min before F18-FDG injection (50 IU/kg)

Clin Nucl Med 2013;38: 128-130.

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CONCLUSIONS:

1) Clinical evaluation, laboratory tests and EC

2) FDG PET/CT could help in unclear cases

3) Total body examination: distant infective foci

4) SUV to assess therapy response

PROTOCOL:• The day before imaging: a very-

low-carbohydrate, high-fat diet and then to fast overnight.

• 45 min before F18-FDG injection: a high-fat, low-carbohydrate beverage.

Univ. Brescia - Bertagna F. Int J Cardiovasc Imaging 2012

High uptake at the mechanical prosthesis ringCT PET/CT FDG

Technical advances: TOF - PSF

SUVmax=10

SUVmax=8

Univ. Brescia - Treglia G. Eur J Nucl Med Mol Imaging 2013

SUVmax=6

CONCLUSIONS:

1) Clinical evaluation, laboratory tests and EC

2) FDG PET/CT could help in unclear cases

3) Total body examination: distant infective foci

4) SUV to assess therapy response

PROTOCOL:• The day before imaging: a very-

low-carbohydrate, high-fat diet and then to fast overnight.

• 45 min before F18-FDG injection: a high-fat, low-carbohydrate beverage.

26/08/2014

14

Mª José García VellosoServicio de Medicina Nuclear

Clínica Universidad de NavarraSpain

Hybrid imaging of cardiovascular infections

Sarajevo (Bosnia & Hercegovina)Thursday, June 19 2014

10:20-11:00 a.m