Abstract
1148
Objectives: The term cardiovascular infection is used to describe a wide range of infections including those of the cardiac valves (native and prosthetic), endocarditis, cardiac implantable electronic devices (CIED), and prosthetic vascular grafts. These infections can be life threatening and prompt, accurate diagnosis is critical for their successful management. Overdiagnosis can lead to unnecessary invasive revision procedures, which can increase morbidity and mortality and impose a substantial healthcare burden on society. Alternatively, the failure to diagnose these infections and institute appropriate treatment can lead to catastrophic consequences. The diagnosis of cardiovascular infections can be challenging and imaging plays an important role in their work-up. Computed tomography and echocardiography, which are widely used, detect infection induced structural alterations such as vegetations, edema, and abscesses, changes which typically manifest late in the course of the disease. Molecular imaging with labeled leukocytes and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), which reflect the host response to infection, identifies the functional changes that accompany infection and potentially can detect these infections before morphological changes become apparent. Both labeled leukocytes and 18F-FDG are powerful tools for detecting cardiovascular infections. The emergence of hybrid imaging, SPECT/CT and PET/CT, has further enhanced the value of molecular imaging. These procedures improve image quality as well as test accuracy by precisely localizing radiopharmaceutical uptake, which is especially helpful when evaluating relatively small structures like the cardiac valves. The objectives of this educational exhibit are to review the pathophysiology, clinical significance, and management of cardiovascular infections, understand the role of anatomic imaging in the diagnosis of these infections, and to demonstrate the value of labeled leukocyte imaging and 18F-FDG PET/CT in the diagnosis and management of these infections as well as identifying remote sites of infection. Methods: This educational exhibit will, in pictorial fashion, illustrate the role of labeled leukocyte scintigraphy and 18F-FDG) PET/CT for diagnosing cardiovascular infections and monitoring response to treatment. The limitations and pitfalls of these techniques also will be reviewed.
Results: N/A Conclusions: Understanding the pathophysiology of cardiovascular infections together with being familiar with the appearance and classic presentation of these infections on molecular imaging studies will assist the Nuclear Medicine Physician in the accurate interpretation of these studies.