Skip to main content

Abstract

The most recent clinical guidelines on the management of infective endocarditis propose findings of multimodality imaging, including nuclear imaging with SPECT/CT or PET/CT, as part of the diagnostic criteria and diagnostic flowchart of infective endocarditis, particularly in patients with suspected prosthetic valve endocarditis. Radiolabelled leukocyte scintigraphy SPECT and 18F-fluorodeoxyglucose PET are sensitive methods to detect sites of infection. Current data indicate that they may contribute to early diagnosis of IE. In this chapter, we will describe the methodology and underlying evidence on the use of nuclear imaging techniques for evaluation of infective endocarditis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Holland TL, Baddour LM, Bayer AS, Hoen B, Miro JM, Fowler VG Jr. Infective endocarditis. Nat Rev Dis Primers. 2016;2:16059.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective endocarditis, 19902–010: a systematic review of the literature. Glob Heart. 2014;9:1311–43.

    Article  Google Scholar 

  3. Habib G, Erba PA, Iung B, Donal E, Cosyns B, Laroche C, Popescu BA, Prendergast B, Tornos P, Sadeghpour A, et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J. 2019;40:32223–32.

    Google Scholar 

  4. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.

    Article  CAS  PubMed  Google Scholar 

  5. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:30753–128.

    Article  Google Scholar 

  6. Habib G, Derumeaux G, Avierinos JF, Casalta JP, Jamal F, Volot F, Garcia M, Lefevre J, Biou F, Maximovitch-Rodaminoff A, et al. Value and limitations of the Duke criteria for the diagnosis of infective endocarditis. J Am Coll Cardiol. 1999;33:20232–029.

    Article  Google Scholar 

  7. Philip M, Tessonier L, Mancini J, Mainardi JL, Fernandez-Gerlinger MP, Lussato D, Attias D, Cammilleri S, Weinmann P, Hagege A, Arregle F, Martel H, Oliver L, Camoin L, Casalta AC, Casalta JP, Gouriet F, Riberi A, Lepidi H, Raoult D, Drancourt M, Habib G. Comparison Between ESC and Duke criteria for the diagnosis of prosthetic valve infective endocarditis. JACC Cardiovasc Imaging. 2020;13(12):2605–15. https://doi.org/10.1016/j.jcmg.2020.04.011.

    Article  PubMed  Google Scholar 

  8. Fukuchi T, Iwata K, Ohji G. Failure of early diagnosis of infective endocarditis in Japan--a retrospective descriptive analysis. Medicine. 2014;93:e237.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Erba PA, Sollini M, Conti U, Bandera F, Tascini C, De Tommasi SM, Zucchelli G, Doria R, Menichetti F, Bongiorni MG, Lazzeri E, Mariani G. Radiolabeled WBC scintigraphy in the diagnostic workup of patients with suspected device-related infections. JACC Cardiovasc Imaging. 2013;6:1075–86.

    Article  PubMed  Google Scholar 

  10. Rouzet F, Chequer R, Benali K, Lepage L, Ghodbane W, Duval X, Iung B, Vahanian A, Le Guludec D, Hyafil F. Respective performance of 18F-FDG PET and radiolabeled leukocyte scintigraphy for the diagnosis of prosthetic valve endocarditis. J Nucl Med. 2014;55:1980–5.

    Article  CAS  PubMed  Google Scholar 

  11. Imbert L, Poussier S, Franken PR, et al. Compared performance of high-sensitivity cameras dedicated to myocardial perfusion SPECT: a comprehensive analysis of phantom and human images. J Nucl Med. 2012;53:1897–903.

    Article  PubMed  Google Scholar 

  12. Lavender JP, Lowe J, Barker JR, Burn JI, Chaudhri MA. Gallium 67 citrate scanning in neoplastic and inflammatory lesions. Br J Radiol. 1971;44:361–6.

    Article  CAS  PubMed  Google Scholar 

  13. Palestro CJ. Molecular imaging of infection: the first 50 years. Semin Nucl Med. 2020;50:23–34.

    Article  PubMed  Google Scholar 

  14. Palestro CJ, Love C. Nuclear medicine imaging in fever of unknown origin: the new paradigm. Curr Pharm Des. 2018;24:814–20.

    Article  CAS  PubMed  Google Scholar 

  15. McWilliams ET, Yavari A, Raman V. Aortic root abscess: multimodality imaging with computed tomography and gallium-67 citrate single-photon emission computed tomography/computed tomography hybrid imaging. J Cardiovasc Comput Tomogr. 2011;5:122–4.

    Article  PubMed  Google Scholar 

  16. Erba PA, Conti U, Lazzeri E, Sollini M, Doria R, De Tommasi SM, et al. Added value of 99mTc-HMPAO-labeled leukocyte SPECT/CT in the characterization and management of patients with infectious endocarditis. J Nucl Med. 2012;53:1235–43.

    Article  CAS  PubMed  Google Scholar 

  17. Lawal IO, Kleyhans J, Mokoala KMG, Vorster M, Ebenhan T, Zeevaart JR, Sathekge MM. Single photon emission tomography in the diagnostic assessment of cardiac and vascular infectious diseases. Curr Radiopharm. 2020; https://doi.org/10.2174/1874471013666200621190001. Online ahead of print.

  18. de Vries EFJ, Roca M, Jamar F, Israel O, Signore A. Guidelines for the labelling of leucocytes with 99mTc-HMPAO. Eur J Nucl Med Mol Imaging. 2010;37:842–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Roca M, de Vries EFJ, Jamar F, Israel O, Signore A. Guidelines for the labelling of leucocytes with 111In-oxine. Eur J Nucl Med Mol Imaging. 2010;37:835–41.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hyafil F, Rouzet F, Lepage L, Benali K, Raffoul R, Duval X, Hvass U, Iung B, Nataf P, Lebtahi R, Vahanian A, Le Guludec D. Role of radiolabeled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and inconclusive echocardiography. Eur Heart J. 2013;14:586–94.

    Google Scholar 

  21. Juneau D, Golfam M, Hazra S, Erthal F, Zuckier LS, Bernick J, Wells GA, Beanlands RSB, Chow BJW. Molecular imaging for the diagnosis of infective endocarditis: a systematic literature review and meta-analysis. Int J Cardiol. 2018;253:183–8.

    Article  PubMed  Google Scholar 

  22. Caobelli F, Wollenweber T, Bavendiek U, Kühn C, Schütze C, Geworski L, Thackeray JT, Bauersachs J, Haverich A, Bengel FM. Simultaneous dual-isotope solid-state detector SPECT for improved tracking of white blood cells in suspected endocarditis. Eur Heart J. 2017;38:436–43.

    CAS  PubMed  Google Scholar 

  23. Gomes A, Glaudemans AWJM, Touw DJ, van Melle JP, Willems TP, Maass AH, Natour E, Prakken NHJ, Borra RJH, van Geel PP, Slart RHJA, van Assen S, Sinha B. Diagnostic value of imaging in infective endocarditis: a systematic review. Lancet Infect Dis. 2017;17:e1–e14.

    Article  PubMed  Google Scholar 

  24. Holcman K, Szot W, Rubiś P, Leśniak-Sobelga A, Hlawaty M, Wiśniowska-Śmiałek S, Małecka B, Zabek A, Boczar K, Stępień A, Podolec P, Kostkiewicz M. 99mTc-HMPAO-labeled leukocyte SPECT/CT and transthoracic echocardiography diagnostic value in infective endocarditis. Int J Cardiovasc Imaging. 2019;35:749–58.

    Article  PubMed  Google Scholar 

  25. Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Sághy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;41:2012–32.

    Article  PubMed  Google Scholar 

  26. Małecka BA, Zabek A, Dębski M, Szot W, Holcman K, Boczar K, Ulman M, Lelakowski J, Kostkiewicz M. The usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing lead-dependent infective endocarditis. Adv Clin Exp Med. 2019;28:113–9.

    Article  PubMed  Google Scholar 

  27. Shiraev T, Barrett S, Heywood S, Mirza W, Hunter-Dickson M, Bradshaw C, Hardman D, Neilson S, Bradshaw S. Incidence, management, and outcomes of aortic graft infection. Ann Vasc Surg. 2019;59:73–83.

    Article  PubMed  Google Scholar 

  28. Liberatore M, Misuraca M, Calandri E, Rizzo L, Speziale F, Iurilli AP, Anagnostou C. White blood cell scintigraphy in the diagnosis of infection of endovascular prostheses within the first month after implantation. Med Sci Monit. 2006;12:MT5–9.

    PubMed  Google Scholar 

  29. Khaja MS, Sildiroglu O, Hagspiel K, Rehm PK, Cherry KJ, Turba UC. Prosthetic vascular graft infection imaging. Clin Imaging. 2013;37:239–44.

    Article  PubMed  Google Scholar 

  30. Erba PA, Leo G, Sollini M, Tascini C, Boni R, Berchiolli RN, Menichetti F, Ferrari M, Lazzeri E, Mariani G. Radiolabelled leucocyte scintigraphy versus conventional radiological imaging for the management of late, low-grade vascular prosthesis infections. Eur J Nucl Med Mol Imaging. 2014;41:357–68.

    Article  CAS  PubMed  Google Scholar 

  31. Becker W, Borst U, Fischbach W, Pasurka B, Schäfer R, Börner W. Kinetic data of in-vivo labeled granulocytes in humans with a murine Tc-99m-labelled monoclonal antibody. Eur J Nucl Med. 1989;15:361–6.

    Article  CAS  PubMed  Google Scholar 

  32. Gratz S, Schipper ML, Dörner J, Höffken H, Becker W, Kaiser JW, Béhé M, Behr TM. LeukoScan for imaging infection in different clinical settings: a retrospective evaluation and extended review of the literature. Clin Nucl Med. 2003;28:267–76.

    CAS  PubMed  Google Scholar 

  33. Palestro CJ. Radionuclide imaging of musculoskeletal infection: a review. J Nucl Med. 2016;57:1406–12.

    Article  CAS  PubMed  Google Scholar 

  34. Morguet AJ, Munz DL, Ivančevič V, Werner GS, Sandrock D, Bökemeier M, Kreuzer H. Immunoscintigraphy using technetium-99m-labeled anti-NCA-95 antigranulocyte antibodies as an adjunct to echocardiography in subacute infective endocarditis. J Am Coll Cardiol. 1994;23:1171–8.

    Article  CAS  PubMed  Google Scholar 

  35. Bouter C, Meller B, Sahlmann CO, Meller J. 99mTc-besilesomab-SPECT/CT in infectious endocarditis: upgrade of a forgotten method? Front Med. 2019;6:40.

    Article  Google Scholar 

  36. Saby L, Laas O, Habib G, Cammilleri S, Mancini J, Tessonnier L, Casalta JP, Gouriet F, Riberi A, Avierinos JF, Collart F, Mundler O, Raoult D, Thuny F. Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular 18F-fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol. 2013;61:2374–82.

    Article  PubMed  Google Scholar 

  37. RHJA S, AWJM G, Gheysens O, Lubberink M, Kero T, Dweck MR, Habib G, Gaemperli O, Saraste A, Gimelli A, Georgoulias P, Verberne HJ, Bucerius J, Rischpler C, Hyafil F, Erba PA, 4Is Cardiovascular Imaging: a joint initiative of the European Association of Cardiovascular Imaging (EACVI) and the European Association of Nuclear Medicine (EANM). Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation- (4Is) related cardiovascular diseases: a joint collaboration of the EACVI and the EANM. Eur J Nucl Med Mol Imaging. 2020;48:1016–39. https://doi.org/10.1007/s00259-020-05066-5.

    Article  Google Scholar 

  38. Dorbala S, Di Carli MF, Delbeke D, Abbara S, DePuey EG, Dilsizian V, et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med. 2013;54:1485–507.

    Article  PubMed  Google Scholar 

  39. Osborne MT, Hulten EA, Murthy VL, Skali H, Taqueti VR, Dorbala S, et al. Patient preparation for cardiac fluorine-18 fluorodeoxyglucose positron emission tomography imaging of inflammation. J Nucl Cardiol. 2017;24:86–99.

    Article  PubMed  Google Scholar 

  40. Juneau D, Golfam M, Hazra S, Erthal F, Zuckier LS, Bernick J, et al. Molecular imaging for the diagnosis of infective endocarditis: a systematic literature review and meta-analysis. Int J Cardiol. 2018;253:183–8.

    Article  PubMed  Google Scholar 

  41. Scholtens AM, van Aarnhem EE, Budde RP. Effect of antibiotics on FDGPET/CT imaging of prosthetic heart valve endocarditis. Eur Heart J Cardiovasc Imaging. 2015;16:1223.

    Article  CAS  PubMed  Google Scholar 

  42. Scholtens AM, Swart LE, Verberne HJ, Tanis W, Lam MG, Budde RP. Confounders in FDG-PET/CT imaging of suspected prosthetic valve endocarditis. JACC Cardiovasc Imaging. 2016;9:1462–5.

    Article  PubMed  Google Scholar 

  43. Swart LE, Scholtens AM, Tanis W, Nieman K, Bogers AJJC, Verzijlbergen FJ, Krestin GP, Roos-Hesselink JW, Budde RPJ. 18F-fluorodeoxyglucose positron emission/computed tomography and computed tomography angiography in prosthetic heart valve endocarditis: from guidelines to clinical practice. Eur Heart J. 2018;39:3739–49.

    Article  CAS  PubMed  Google Scholar 

  44. Scholtens AM, Budde RPJ, Lam MGEH, Verberne HJ. FDG PET/CT in prosthetic heart valve endocarditis: there is no need to wait. J Nucl Cardiol. 2017;24:1540–1.

    Article  CAS  PubMed  Google Scholar 

  45. Swart LE, Gomes A, Scholtens AM, Sinha B, Tanis W, Lam MGEH, van der Vlugt MJ, Streukens SAF, Aarntzen EHJG, Bucerius J, van Assen S, Bleeker-Rovers CP, van Geel PP, Krestin GP, van Melle JP, Roos-Hesselink JW, Slart RHJA, Glaudemans AWJM, Budde RPJ. Improving the diagnostic performance of 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography in prosthetic heart valve endocarditis. Circulation. 2018;138:1412–27.

    Article  PubMed  Google Scholar 

  46. Mathieu C, Mikaïl N, Benali K, Iung B, Duval X, Nataf P, Jondeau G, Hyafil F, Le Guludec D, Rouzet F. Characterization of (18) F-Fluorodeoxyglucose uptake pattern in noninfected prosthetic heart valves. Circ Cardiovasc Imaging. 2017;10:e005585.

    PubMed  Google Scholar 

  47. Pizzi MN, Roque A, Fernández-Hidalgo N, Cuéllar-Calabria H, Ferreira-González I, Gonzàlez-Alujas MT, et al. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-fluordeoxyglucose positron emission tomography/computed tomography angiography: initial results at an infective endocarditis referral center. Circulation. 2015;132:1113–26.

    Article  PubMed  Google Scholar 

  48. Scholtens AM, Swart LE, Kolste HJT, Budde RPJ, Lam MGEH, Verberne HJ. Standardized uptake values in FDG PET/CT for prosthetic heart valve endocarditis: a call for standardization. J Nucl Cardiol. 2018;25:2084–91.

    Article  PubMed  Google Scholar 

  49. Salomäki SP, Saraste A, Kemppainen J, Bax JJ, Knuuti J, Nuutila P, Seppänen M, Roivainen A, Airaksinen J, Pirilä L, Oksi J, Hohenthal U. 18F-FDG positron emission tomography/computed tomography in infective endocarditis. J Nucl Cardiol. 2017;24:195–206.

    Article  PubMed  Google Scholar 

  50. Asmar A, Ozcan C, Diederichsen AC, Thomassen A, Gill S. Clinical impact of 18F-FDG-PET/CT in the extra cardiac work-up of patients with infective endocarditis. Eur Heart J Cardiovasc Imaging. 2014;15:1013–9.

    Article  PubMed  Google Scholar 

  51. Van Riet J, Hill EE, Gheysens O, Dymarkowski S, Herregods MC, Herijgers P, et al. (18)F-FDG PET/CT for early detection of embolism and metastatic infection in patients with infective endocarditis. Eur J Nucl Med Mol Imaging. 2010;37:1189–97.

    Article  PubMed  Google Scholar 

  52. Bonfiglioli R, Nanni C, Morigi JJ, Graziosi M, Trapani F, Bartoletti M, et al. 18F-FDG PET/CT diagnosis of unexpected extracardiac septic embolisms in patients with suspected cardiac endocarditis. Eur J Nucl Med Mol Imaging. 2013;40:1190–6.

    Article  CAS  PubMed  Google Scholar 

  53. Kestler M, Munoz P, Rodriguez-Creixems M, Rotger A, Jimenez-Requena F, Mari A, et al. Role of (18)F-FDG PET in patients with infectious endocarditis. J Nucl Med. 2014;55:1093–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antti Saraste .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Saraste, A., Caobelli, F. (2021). Endocarditis. In: Caobelli, F. (eds) Imaging of Inflammation and Infection in Cardiovascular Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-81131-0_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81131-0_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81130-3

  • Online ISBN: 978-3-030-81131-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics