18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in the diagnosis of extracardiac foci of inflammation in patients with suspected prosthetic valve infective endocarditis

Authors: Golukhova E.Z., Aslanidis I.P., Pursanova D.M., Mukhortova O.V., Shurupova I.V., Katunina T.A., Aleksandrova S.A., Tetvadze I.V.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2020-14-3-245-254

For citation: Golukhova E.Z., Aslanidis I.P., Pursanova D.M., Mukhortova O.V., Shurupova I.V., Katunina T.A., Aleksandrova S.A., Tetvadze I.V. 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in the diagnosis of extracardiac foci of inflammation in patients with suspected prosthetic valve infective endocarditis. Creative Cardiology. 2020; 14 (3): 245–54 (in Russ.). DOI: 10.24022/1997-3187-2020-14-3-245-254

Received / Accepted:  23.09.2020 / 25.09.2020

Keywords: positron emission tomography combined with computed tomography 18F-fluorodeoxyglucose infectious process infectious endocarditis prosthetic valve foci of inflammation

Full text:  

 

Abstract

Objective. To investigate the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in the diagnosis of extracardiac foci of inflammation in patients with suspected prosthetic valve infective endocarditis (IE PV).

Material and methods. The prospective analysis included results of PET/CT examinations performed in 55 patients with fever of unknown origin after heart valve implantation (median time 32 months). PET/CT scan was performed 90 min after intravenous injection of 18F-FDG (175-200MBq). All patients underwent strict carbohydrate-free diet and fasted for at least 15–18 hours. Final diagnosis was based on clinical, laboratory, instrumental and intraoperative (n=40) data: confirmed in 37 and ruled out in 18 patients.

Results. PET/CT results correctly confirmed the infectious process in the prosthetic valve area in 34 (92%) out of 37 and ruled it out in 12 (67%) out of 18 patients. False results were obtained in 9 (16%) out of 55 – positive (n=6) and negative (n=3). In 28 (51%) out of 55 of patients of the analyzed group, the “whole body” PET/CT examination allowed not only to assess the zone of interest (prosthetic valve ), but also to identify previously unknown foci of inflammation of other localization. In total, 39 foci of inflammation other than valve area were diagnosed: along vascular grafts (n=10), in lung parenchyma and pleura (n=7), in sternum (n=6), in other various parts of the mediastinum (n=6), other localization (n=10). Among the patients with subsequently excluded PC IE (n=18), PET/CT allowed to determine the possible cause of increased body temperature in 7 (39%) out of 18 patients. In addition, “whole body” PET/CT in 1 (2%) out of 55 patient with true positive result in the valve area simultaneously detected a previously unknown cancer of the colon, which was subsequently verified.

Conclusion. 18F-FDG PET/CT proved to be highly informative for the diagnosis of extracardiac foci of inflammation in patients with suspected prosthetic valve endocarditis. The “whole body” examination allows one to simultaneously diagnose previously unknown extracardiac foci of inflammation, as well as neoplastic processes.

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About Authors

  • Elena Z. Golukhova, Dr. Med. Sc., Professor, Academician of RAS, Chief of Chair, Acting Head of Bakoulev National Medical Research Center for Cardiovascular Surgery, Deputy Chief Editor of the Journal, ORCID
  • Iraklis P. Aslanidis, Dr. Med. Sc., Professor, Head of Department, ORCID
  • Diana M. Pursanova, Cand. Med. Sc., Senior Researcher, ORCID
  • Ol'ga V. Mukhortova, Dr. Med. Sc., Senior Researcher, ORCID
  • Irina V. Shurupova, Dr. Med. Sc., Senior Researcher, ORCID
  • Tat’yana A. Katunina, Researcher, ORCID
  • Svetlana A. Aleksandrova, Cand. Med. Sc., Senior Researcher, ORCID
  • Inga V. Tetvadze, Cand. Med. Sc., Head Physician of V.I. Bourakovsky Institute of Cardiac Surgery, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery