University of Maryland School of Medicine, Baltimore, MD, USA,
Curr Cardiol Rep. 2014 Mar;16(3):459. doi: 10.1007/s11886-013-0459-y.
Diagnosis of cardiac mechanical device or prosthesis valve infection, and more importantly accurate localization of the infection site, such as defibrillator pocket, pacemaker lead, annular or peri-annular valve ring abscesses remain clinically challenging. Inconclusive diagnosis can lead to delayed antibiotic therapy, device extraction or surgical intervention, which may have dire consequences to the patient. Among patients with suspected cardiac mechanical device or prosthetic valve infection, recent publications advocate the use of (18)F-fluoro-2-deoxyglucose positron emission tomography computed tomography (FDG PET/CT), particularly when anatomy based imaging studies, such as echocardiography or CT, are uncertain or negative. A potential advantage of FDG PET/CT is in its detection of inflammatory cells early in the infection process, before morphologic damages ensue. However, there are many unanswered questions in the literature. There is a need for standardization amongst the various imaging studies, such as dietary preparation, duration and timing of image acquisition, image processing with and without CT attenuation correction, and more importantly image interpretation criteria. The answer for these issues awaits well designed, prospective studies.
心脏机械装置或假体瓣膜感染的诊断，更重要的是准确定位感染部位，如除颤器囊袋、起搏器导线、瓣环或瓣周脓肿，仍然具有临床挑战性。诊断不明确可能导致抗生素治疗延迟、器械取出或手术干预，这可能对患者产生严重后果。在疑似心脏机械装置或人工瓣膜感染的患者中，最近的出版物提倡使用 (18)F-氟代-2-脱氧葡萄糖正电子发射断层扫描计算机断层扫描（FDG PET/CT），特别是在解剖结构成像研究（如超声心动图或 CT）不确定或为阴性时。FDG PET/CT 的一个潜在优势在于它可以在感染过程的早期检测到炎症细胞，在形态损伤发生之前。然而，文献中仍有许多悬而未决的问题。需要对各种成像研究进行标准化，例如饮食准备、图像采集的持续时间和时间、有无 CT 衰减校正的图像处理，以及更重要的是图像解释标准。这些问题的答案有待精心设计的前瞻性研究来回答。
