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18F-FDG PET/CT diagnosis of unexpected extracardiac septic embolisms in patients with suspected cardiac endocarditis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Acute infective endocarditis is a potentially life-threatening disease. Its outcome strongly depends on systemic embolization and extracardiac infections. When present, these conditions usually lead to a more aggressive therapeutic approach. However, the diagnosis of peripheral septic embolism is very challenging. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT has proven to be accurate for the detection of inflammatory diseases and occult infections. The aim of this study was to assess the added value of 18F-FDG PET/CT in the detection of extracardiac embolisms in the evaluation of patients with suspected valvular endocarditis (VE).

Methods

Seventy-one patients with suspected infective endocarditis, enrolled between June 2010 and December 2012, underwent 18F-FDG PET/CT with the standard procedure on a dedicated PET/CT scanner. Extracardiac findings were subsequently evaluated with other imaging procedures.

Results

Of the 71 patients with suspicion of infective endocarditis, we found unexpected extracardiac findings in 17 patients (24 %) without any clinical suspicion. Extracardiac findings were subsequently evaluated with other imaging procedures.

Conclusion

PET/CT detected unexpected extra sites of infection in 24 % of cases, leading to changes in therapeutic management in a very relevant percentage of patients. These findings may have important therapeutic implications.

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Authors and Affiliations

  1. Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy

    Rachele Bonfiglioli, Cristina Nanni, Joshua James Morigi, Valentina Ambrosini & Stefano Fanti

  2. Cardiology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy

    Maddalena Graziosi & Claudio Rapezzi

  3. Infective Diseases, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy

    Filippo Trapani, Michele Bartoletti, Fabio Tumietto & Pier Luigi Viale

  4. Nuclear Medicine, Radiology, Neuroradiology, Medical Physics, Azienda Ospedaliera S. Maria della Misericordia, Rovigo, Italy

    Alice Ferretti & Domenico Rubello

Authors
  1. Rachele Bonfiglioli
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  2. Cristina Nanni
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  3. Joshua James Morigi
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  4. Maddalena Graziosi
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  7. Fabio Tumietto
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  9. Alice Ferretti
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  10. Domenico Rubello
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  12. Pier Luigi Viale
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  13. Stefano Fanti
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Corresponding author

Correspondence to Domenico Rubello.

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Bonfiglioli, R., Nanni, C., Morigi, J.J. et al. 18F-FDG PET/CT diagnosis of unexpected extracardiac septic embolisms in patients with suspected cardiac endocarditis. Eur J Nucl Med Mol Imaging 40, 1190–1196 (2013). https://doi.org/10.1007/s00259-013-2426-7

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  • DOI: https://doi.org/10.1007/s00259-013-2426-7

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