Amraoui Sana, Tlili Ghoufrane, Sohal Manav, Berte Benjamin, Hindié Elif, Ritter Philippe, Ploux Sylvain, Denis Arnaud, Derval Nicolas, Rinaldi Christopher A, Cazanave Charles, Jais Pierre, Haissaguerre Michel, Bordenave Laurence, Bordachar Pierre
Université de Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France.
CHU de Bordeaux, Service de Médecine Nucléaire et CIC 1401, Bordeaux, France.
JACC Cardiovasc Imaging. 2016 Mar;9(3):283-90. doi: 10.1016/j.jcmg.2015.09.014. Epub 2016 Feb 17.
The aim of this study was to investigate the role of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scanning in identifying septic embolism in patients with lead endocarditis.
Lead endocarditis may be associated with septic embolism, in which case the administration mode, type, and duration of antibiotic therapy must be adapted. However, diagnosis can be challenging: magnetic resonance imaging (MRI) cannot be performed in the vast majority of patients with cardiac implantable electronic devices (CIEDs). FDG PET/CT scanning has been proposed as a diagnostic tool for suspected CIED infection.
Thirty-five consecutive patients with lead endocarditis were prospectively studied. FDG PET/CT scanning was performed and analyzed blindly by experienced nuclear medicine physicians to assess for the presence of septic embolism 2 days before lead extraction.
FDG PET/CT scanning identified septic emboli in 10 patients (29%): 7 with spondylodiscitis, 2 with septic pulmonary emboli, and 1 with an infected vascular prosthesis. Among the 7 patients with occult spondylodiscitis, 4 were asymptomatic, and 3 had back pain with negative CT imaging, MRI being contraindicated due to non MRI-compatible CIEDs. Antimicrobial therapy was adapted (double antibiotic therapy with good bone penetration) and prolonged. Among other important ancillary findings, 3 patients presented focal FDG uptake in the colon (1 adenocarcinoma, and 2 resected polyps) and 2 in the esophagus (both cases confirmed as neoplasia).
This study emphasizes the potential utility of FDG PET/CT scanning as a diagnostic tool for septic emboli in patients with pacing lead endocarditis. This promising diagnostic tool may be integrated in the diagnostic algorithm of patients with lead endocarditis because diagnosis of septic embolisms has a direct and significant impact on the therapeutic care pathway.
本研究旨在探讨18-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）在识别起搏器心内膜炎患者脓毒性栓塞中的作用。
起搏器心内膜炎可能与脓毒性栓塞有关，在这种情况下，必须调整抗生素治疗的给药方式、类型和持续时间。然而，诊断可能具有挑战性：绝大多数植入心脏电子设备（CIED）的患者无法进行磁共振成像（MRI）检查。FDG PET/CT扫描已被提议作为疑似CIED感染的诊断工具。
对35例连续的起搏器心内膜炎患者进行前瞻性研究。在拔除起搏器导线前两天，由经验丰富的核医学医师对FDG PET/CT扫描结果进行盲法分析，以评估是否存在脓毒性栓塞。
FDG PET/CT扫描在10例患者（29%）中发现了脓毒性栓子：7例为脊椎椎间盘炎，2例为脓毒性肺栓塞，1例为感染的血管假体。在7例隐匿性脊椎椎间盘炎患者中，4例无症状，3例有背痛但CT成像为阴性，由于CIED与MRI不兼容，无法进行MRI检查。调整了抗菌治疗方案（采用具有良好骨渗透性的双重抗生素治疗）并延长了疗程。在其他重要的辅助检查结果中，3例患者结肠出现局灶性FDG摄取（1例腺癌，2例切除息肉），2例患者食管出现局灶性FDG摄取（均确诊为肿瘤）。
本研究强调了FDG PET/CT扫描作为诊断起搏器心内膜炎患者脓毒性栓子的潜在实用价值。这种有前景的诊断工具可纳入起搏器心内膜炎患者的诊断流程，因为脓毒性栓塞的诊断对治疗护理路径有直接且显著的影响。
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