18 F-FDG PET/CT in cardiovascular infection and inflammation

• Published in: Revista Española de medicina nuclear e imagen molecular (English ed.) Vol. 40; no. 6; p. 397
• Main Authors: Casáns-Tormo, I, Alcalá-López, J E, Espinet-Coll, C, Pubul-Núñez, V, Martínez-Rodríguez, I
• Format: Journal Article
• Language: English
• Published: Spain 01.11.2021
• Subjects: Brain - diagnostic imaging; Cardiovascular Infections - diagnostic imaging; Defibrillators, Implantable - adverse effects; Echocardiography; Endocarditis - diagnostic imaging; Fluorodeoxyglucose F18; Giant Cell Arteritis - diagnostic imaging; Heart - diagnostic imaging; Heart Valve Prosthesis - adverse effects; Heart-Assist Devices - adverse effects; Humans; Magnetic Resonance Imaging; Pacemaker, Artificial - adverse effects; Positron Emission Tomography Computed Tomography - methods; Prognosis; Prostheses and Implants; Prosthesis-Related Infections - diagnostic imaging; Radiopharmaceuticals; Takayasu Arteritis - diagnostic imaging; Tomography, X-Ray Computed; Vasculitis - diagnostic imaging; Implantable cardiac device; Vasculitis de grandes vasos; Nuclear cardiology; PET/TC; Cardiología nuclear; F-FDG; Endocarditis infecciosa; Prosthetic valves; Prótesis valvular; Large vessel vasculitis; PET/CT; Infective endocarditis; Dispositivo intracardíaco

The diagnosis of cardiovascular infection and inflammation by [ F]FDG PET/CT in Nuclear Cardiology is of growing interest, because with respect to echocardiography this technique has improved the certainty in the diagnosis of infective endocarditis in patients with prosthetic valves, the increasing number of patients with implantable cardiac devices because of the progressive ageing of the population, as well as in patients with suspected large vessel vasculitis. All are serious clinical situations which require correct diagnosis and appropriate treatment as soon as possible, because they can cause severe complications, high mortality and also increased health care costs. We review the use of [ F]FDG PET/CT in cardiovascular infection and inflammation, including the clinical point of view and the contribution of other image modalities. We focus on the appropriate methodology for this exploration, patient preparation, image acquisition and correct interpretation and the quantification possibilities, defining the specific characteristics of the diagnosis in patients with prosthetic valves, implantable cardiac devices and large vessel vasculitis in the initial diagnosis as well as during follow-up to assess treatment response. We analyze the possible causes of false positive and false negative results and emphasize the special value of a multidisciplinary team for optimal management of these patients.