Saxena Awiral, Sarma Manjit, Bhad Bhagirath, Ratheesan Ramkesh, Subramanyam Padma, Sundaram P Shanmuga
Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Science, Kochi, Kerala, India.
Asia Ocean J Nucl Med Biol. 2024;12(2):161-169. doi: 10.22038/AOJNMB.2024.77504.1547.
With the increasing number of interventional cardiology procedures, the number of cardiac device infections (including pacemakers, prosthetic valves, coronary and aortic stents) have also increased. These infections can cause significant morbidity and can even lead to mortality if not managed promptly. If suspected clinically the first-line imaging modality is Trans-Thoracic Echocardiography, while Transesophageal Echocardiography is also used in selected cases. The confirmation of a cardiac device infection is mostly done with the help of blood or pus culture. Even though Echocardiography is a very efficient technique for the evaluation of the heart, it cannot differentiate infection from thrombus or fibrosis. With the increasing availability of Positron Emission Tomography CT (PET CT) machines worldwide, the use of F-FDG PET CT for infection imaging has gained traction, especially for cardiac device infection. Most of the recent studies show a good diagnostic accuracy of F-FDG PET CT with many of the recent diagnostic and management guidelines now acknowledging its role, especially in equivocal cases. We present six such cases where F-FDG PET CT provided valuable information either for diagnosis, confirming the presence of infection, delineating extent, therapy response or sometimes even helping appropriate treatment decision making in patients with suspected cardiac device infection.
随着介入心脏病学手术数量的增加，心脏装置感染（包括起搏器、人工瓣膜、冠状动脉和主动脉支架）的数量也有所上升。这些感染可导致严重的发病情况，若不及时处理甚至会导致死亡。如果临床上怀疑有感染，一线成像方式是经胸超声心动图，而在某些特定情况下也会使用经食管超声心动图。心脏装置感染的确诊大多借助血液或脓液培养。尽管超声心动图是评估心脏的一种非常有效的技术，但它无法区分感染与血栓或纤维化。随着正电子发射断层扫描CT（PET CT）机在全球范围内的普及，F-FDG PET CT用于感染成像越来越受到关注，尤其是对于心脏装置感染。最近的大多数研究表明，F-FDG PET CT具有良好的诊断准确性，许多最新的诊断和管理指南现在都认可其作用，特别是在疑难病例中。我们展示了6例这样的病例，其中F-FDG PET CT为疑似心脏装置感染的患者提供了有价值的信息，无论是用于诊断、确认感染的存在、确定范围、评估治疗反应，有时甚至有助于做出恰当的治疗决策。
