F-18 FDG PET/CT imaging of cardiac and vascular inflammation and infection

Introduction: Inflammation forms an important core of the aetiopathogenic process involved in many diseases affecting the heart and the blood vessels. These diseases include infections as well as inflammatory non-infectious cardiovascular conditions. The common feature of this is invasion of the heart or blood vessel by inflammatory cells. F-18 2-fluoro 2-deoxy-D glucose (FDG) is an analogue of glucose and like glucose it is taken up by activated inflammatory cells that accumulate at the site of infection. This has formed the basis of the use of F-18 FDG PET/CT in the non-invasive evaluation of human inflammatory diseases.

Sources of data: This review is based on the published academic articles as well as our clinical experience.

Areas of agreement: F-18 FDG PET/CT is a useful imaging modality in the evaluation of cardiovascular inflammatory disorders. Accumulation and distribution of F-18 FDG at the site of inflammation/infection corresponds to severity of the inflammation/infection and extent of involvement.

Areas of controversy: Most studies evaluating utility of F-18 FDG PET/CT in imaging cardiovascular inflammation are small observational studies hence are potentially prone to bias.

Growing points: Being a hybrid metabolic and morphologic imaging technique, F-18 FDG PET/CT offers combined advantage of complementary anatomic and metabolic information in disease process. This makes it a useful modality in the diagnosis, determination of extent of disease, prognostication as well as treatment monitoring.

Areas timely for developing research: Larger prospective studies are needed to validate the superiority of F-18 FDG PET/CT imaging over conventional anatomic imaging modalities.