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The detection of infectious endocarditis may be enhanced by a repeat FDG-PET while maintaining patients on a ketogenic diet

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

This study aims to determine whether the suppression of myocardial FDG uptake and detection of infectious endocarditis (IE) may be enhanced when FDG-PET is repeated on the next day while maintaining patients on a ketogenic diet in the interim.

Methods

Seventeen patients with definite IE underwent FDG-PET investigations both after a conventional metabolic preparation (> 12-hour fast after a low-carbohydrate evening meal) and a subsequent 12-hour extension of the low-carbohydrate diet followed by an additional > 12-hour fast.

Results

Plasma biomarkers showed increased ketogenic metabolism between the two FDG-PET scans. A myocardial FDG uptake persisted on the 1st PET in 9 patients (53%) for whom myocardial FDG uptake decreased significantly on the 2nd PET (SUVmax: 6.05 ± 3.25 vs 4.32 ± 3.47, P = 0.021), resulting in an enhancement in the diagnostic confidence of IE in 6 cases. These enhancements were not documented in the 8 patients exhibiting a total suppression of myocardial FDG uptake on the 1st PET.

Conclusions

Better suppression of myocardial uptake and enhanced detection of IE may be achieved when an FDG-PET, showing an incomplete suppression of the myocardial FDG uptake, is repeated as soon as the next day, while maintaining patients on a ketogenic diet in the interim.

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Abbreviations

CT:

Computed tomography

FDG:

18F-Fluorodesoxyglucose

IE:

Infective endocarditis

LV:

Left ventricle

MS:

Myocardial suppression

OSEM:

Ordered subset expectation maximization

PET:

Positron emission tomography

SD:

Standard deviation

SUV:

Standardized uptake value

VOI:

Volume of interest

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Acknowledgements

The authors wish to thank Dr. Petra Neufing for critical review of the manuscript, as well as the University Hospital of Nancy and the Nancyclotep Imaging Platform for providing funding.

Disclosures

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine and Nancyclotep molecular imaging platform, CHRU-Nancy, Université de Lorraine, 54000, Nancy, France

    Marine Germaini MD, Caroline Boursier MD, Véronique Roch MSc, Laetitia Imbert PhD, Marine Claudin MD, Elodie Chevalier MD & Pierre-Yves Marie MD, PhD

  2. Department of Infectious Diseases, CHRU-Nancy, 54000, Nancy, France

    François Goehringer MD

  3. Department of Cardiology, CHRU-Nancy, 54000, Nancy, France

    Christine Selton-Suty MD

  4. Université de Lorraine, APEMAC, 54000, Nancy, France

    Benjamin Lefevre MD

  5. Infectious and Tropical Diseases, CHRU-Nancy, 54000, Nancy, France

    Benjamin Lefevre MD

  6. Université de Lorraine, INSERM, UMR 1254, 54000, Nancy, France

    Laetitia Imbert PhD

  7. Université de Lorraine, INSERM, UMR 1116, 54000, Nancy, France

    Pierre-Yves Marie MD, PhD

Authors
  1. Marine Germaini MD
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  2. Caroline Boursier MD
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  3. François Goehringer MD
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  4. Christine Selton-Suty MD
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  5. Benjamin Lefevre MD
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  6. Véronique Roch MSc
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  7. Laetitia Imbert PhD
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  8. Marine Claudin MD
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  9. Elodie Chevalier MD
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  10. Pierre-Yves Marie MD, PhD
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Corresponding author

Correspondence to Pierre-Yves Marie MD, PhD.

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Germaini, M., Boursier, C., Goehringer, F. et al. The detection of infectious endocarditis may be enhanced by a repeat FDG-PET while maintaining patients on a ketogenic diet. J. Nucl. Cardiol. 29, 3256–3262 (2022). https://doi.org/10.1007/s12350-022-02921-w

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  • DOI: https://doi.org/10.1007/s12350-022-02921-w

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