Cardiac imaging in infectious endocarditis
Niels Eske Bruun1, Gilbert Habib, Franck Thuny
1Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup 2900, Denmark.
Insights
Diagnosing infectious endocarditis requires rapid imaging. While echocardiography is key, advanced molecular imaging like (18)F-FDG PET-CT shows promise for better diagnosis and patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- Infectious endocarditis presents diagnostic and therapeutic challenges.
- Effective management hinges on prompt diagnosis, risk assessment, and diligent follow-up.
- Diagnostic imaging is crucial at all stages of endocarditis patient care.
Purpose of the Study:
- To review the role of various imaging modalities in diagnosing and managing infectious endocarditis.
- To compare the utility of conventional echocardiography with emerging molecular imaging techniques.
- To propose an imaging flowchart for both left-sided and right-sided endocarditis.
Main Methods:
- Echocardiography (transthoracic, transesophageal, 3D real-time) for structural assessment.
- Molecular imaging: (18)F-fluorodeoxyglucose (FDG) PET-CT and SPECT/CT for cellular/molecular processes.
- MRI and spiral CT for identifying extra-cardial infectious sources.
Main Results:
- Echocardiography remains the primary tool for visualizing cardiac structural abnormalities in endocarditis.
- (18)F-FDG PET-CT demonstrates significant potential for improving endocarditis diagnosis at the molecular level.
- SPECT/CT and (18)F-FDG PET-CT have limitations that require careful consideration.
- MRI and CT are valuable for detecting infections outside the heart.
Conclusions:
- A multimodal imaging approach is essential for comprehensive endocarditis management.
- (18)F-FDG PET-CT offers promising advancements beyond traditional echocardiography.
- A structured imaging strategy, including a proposed flowchart, can optimize patient care for infectious endocarditis.
Abstract:
Infectious endocarditis remains both a diagnostic and a treatment challenge. A positive outcome depends on a rapid diagnosis, accurate risk stratification, and a thorough follow-up. Imaging plays a key role in each of these steps and echocardiography remains the cornerstone of the methods in use. The technique of both transthoracic echocardiography and transoesophageal echocardiography has been markedly improved across the last decades and most recently three-dimensional real-time echocardiography has been introduced in the management of endocarditis patients. Echocardiography depicts structural changes and abnormalities in the heart, but it does not uncover the underlying pathophysiological processes at the cellular or molecular level. This problem is addressed with introduction of new molecular imaging methods as (18)F-fluorodesoxyglucose ((18)F-FDG) PET-CT and single photon emission computed tomography fused with conventional CT (SPECT/CT). Of these methods, (18)F-FDG PET-CT carries the best promise for a future role in endocarditis. But there are distinct limitations with both SPECT/CT and (18)F-FDG PET-CT which should not be neglected. MRI and spiral CT are methods primarily used in the search for extra cardial infectious foci. A flowchart for the use of imaging in both left-sided and right-sided endocarditis is suggested.
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