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99mTc-HMPAO WBC SPECT/CT in the evaluation of endocarditis and cardiac devices infection

¹ Nuclear Medicine, University of Pisa, Pisa, Italy; ² Cardiovascular Disease; ³ Infectious Disease, AOUP, Pisa, Italy

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Objectives: Despite advances in medical imaging, endocarditis remains a challenging diagnostic problem. Due to expanding cardiac interventions and elderly population, pts at risk of endocarditis are increasing. Diagnosis is based upon positive echocardiography and blood culture (modified Duke criteria). However, in a number of clinical situation Duke criteria aren’t definitive for diagnosis. 99mTc-HMPAO-WBC SPECT/CT scintigraphy is routinely used in infection and imaging has added value in defining the disease extent. In this work we assessed the diagnostic power SPECT/CT with WBC in pts with suspected endocarditis.

Methods: 78 pts(31/47:F/M) with high suspicious of endocarditis (n=60, TTE/TEE-positive=24%,positive blood culture=32%,both positive=29% and both negative with persistent fever=15%) and cardiac devices infection (n=19) were referred for WBC. Whole-body, spot and SPECT/CT imaging were performed at 30min,6/24h post-injection. SPECT/CT findings were compared to follow-up TTE/TEE findings, response to treatment and clinical follow-up.

Results: Planar and SPECT/CT scintigraphy were negative in 36/79 and positive in 43/79 pts. Among the positive pts, 23 cases presented cardiac/device involvement, 15 only extracardiac infection and 5 cases both cardiac foci and distant emboli. We observed additional extracardiac foci in pts with positive echo, and positive findings in about 25% of negative echo/blood culture cases.

Conclusions: These results show the high diagnostic potential of 99mTc-HMPAO-WBC SPECT/CT. The detection of distant emboli in TTE/TEE-positive pts and the identification of cardiac/extracardiac infectious sites in presence of both negative echo and blood culture are valuable.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Erba, P. Articles by Mariani, G. PubMed Articles by Erba, P. Articles by Mariani, G.