18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS

Author:

Bourque Jamieson M1,Birgersdotter-Green Ulrika2,Bravo Paco E3,Budde Ricardo P J4,Chen Wengen5,Chu Vivian H6,Dilsizian Vasken5,Erba Paola Anna7,Gallegos Kattan Cesia8,Habib Gilbert9,Hyafil Fabien10,Khor Yiu Ming11,Manlucu Jaimie12,Mason Pamela Kay13,Miller Edward J8,Moon Marc R14,Parker Matthew W15,Pettersson Gosta16,Schaller Robert D17,Slart Riemer H J A18,Strom Jordan B19,Wilkoff Bruce L20,Williams Adam21,Woolley Ann E22,Zwischenberger Brittany A21,Dorbala Sharmila23

Affiliation:

1. Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System , Charlottesville, VA , USA

2. Division of Cardiology, UC San Diego Health , San Diego, CA , USA

3. Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania , Philadelphia, PA , USA

4. Department of Radiology and Nuclear Medicine , Erasmus MC, University Medical Center, Rotterdam , the Netherlands

5. University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine , Baltimore, MD , USA

6. Division of Infectious Diseases, Duke University School of Medicine , Durham, NC , USA

7. Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine , ASST Ospedale Papa Giovanni XXIII, Bergamo , Italy

8. Nuclear Cardiology, Yale University School of Medicine , New Haven, CT , USA

9. Cardiology Department, Hôpital La Timone , Marseille , France

10. Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris , Paris , France

11. Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital , Singapore

12. London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital) , London, Ontario , Canada

13. Cardiovascular Medicine, University of Virginia Health System , Charlottesville, VA , USA

14. Division of Cardiothoracic Surgery, Baylor College of Medicine , Houston, TX , USA

15. Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine , Worcester, MA , USA

16. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic , Cleveland, OH , USA

17. Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania , Philadelphia, PA , USA

18. Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen , Groningen , the Netherlands

19. Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School , Boston, MA , USA

20. Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University , Cleveland, OH , USA

21. Brigham and Women’s Hospital , Boston, MA , USA

22. Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center , Durham, NC , USA

23. Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School , Boston, MA , USA

Abstract

Abstract This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.

Publisher

Oxford University Press (OUP)

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