Abstract
Rapid and accurate diagnosis of cardiovascular device infection remains a challenge in the clinic. Anatomical imaging tools such as echocardiography and cardiac CT/CTA are the first line modalities for clinically suspected endocarditis given their ability to detect vegetation and peri-valvular complications. Accumulating data suggest that functional imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT has unique merits over anatomical imaging and could potentially diagnose early cardiac device infection before morphologic damage ensues, and identify infection source and/or bacterial emboli in the rest of the body. While an abnormal finding on FDG PET/CT was added to the 2015 guidelines of the European Society of Cardiology as a major criterion for the diagnosis of device related and prosthetic valve endocarditis, the latter has not been incorporated in the US guidelines. Beyond these clinically available imaging tools, attempts have been made to develop bacterial targeting tracers for specific infection imaging, which include tracers of bacterial maltodextrin transporter, bacterial thymidine kinase, antibiotics, antimicrobial peptides, bacterial antibodies, bacteriophages and bacterial DNA/RNA hybrid nucleotide oligomers. Most of the tracers have been studied only in experimental animals, except for radiolabeled antibiotics which have been examined in humans without success in clinical translation for infection imaging. In this article, we compare the roles of anatomical and functional based imaging for cardiac device infection, and discuss the pros and cons of FDG and bacterial targeting tracer. We recommend that FDG PET/CT, which represents host pathogen immune response to infection, should be used clinically for identifying cardiovascular device infection, while anticipating continued investigations for bacterial specific tracer in the future.
- Cardiology (clinical)
- Infectious Disease
- PET/CT
- FDG PET/CT
- bacteria
- cardiovascular device
- infection
- maltodextrin transporter
- Copyright © 2020 by the Society of Nuclear Medicine and Molecular Imaging, Inc.