18FDG-positron emission tomography (PET) has a role to play in the diagnosis and therapy of infective endocarditis and cardiac device infection

Abstract

In recent years, molecular imaging with positron emission tomography (PET) and more recently, PET coupled with computed tomography (CT) have made a valuable impact in various clinical arenas, primarily within the field of oncology, but also in cardiovascular medicine, particularly in detecting coronary artery disease and myocardial viability. More recently, PET imaging has been proven useful in the diagnosis and evaluation of inflammation and infection at different organ sites. Application of PET in the case of Infective Endocarditis (IE) is still in its infancy and indeed the value of this application in the detection of vegetations is debated primarily due to sensitivity issues of the tracer in cardiac tissue and small vegetations. Interestingly, however, reports are now emerging highlighting the role that this application has played in the diagnosis, assessment of complications such as emboli and metastatic infection and the monitoring of therapeutic treatment of IE. More recently, PET/CT has proven valuable in the diagnosis and assessment of cardiac implantable electronic device (CIED)-related infection and its use has highlighted the contribution that this imaging modality may play in assessing the need for surgery in patients with such infections. This article reviews the literature with regard to the potential value of 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)FDG)-PET, as well as the pitfalls and limitations of this imaging modality, in relation to cardiac infection. The emerging role (18)FDG-PET/CT has in the diagnosis and monitoring of IE, particularly prosthetic valve IE and CIED-related infections should be considered, particularly in difficult cases.

Keywords: Cardiac device; Culture-negative; Infection; Infective endocarditis; Pacemaker; Positron emission tomography (PET).