He La Luz University Hospital is a pioneer in the application of PET-CT metabolic imaging for detection of infective endocarditis, a technique indicated in patients with doubtful diagnosis by usual means. Infective endocarditis is a disease with great clinical variability, the manifestation of which is sometimes derived from its complications, among which embolic phenomena stand out. Doctor Antonio Maldonadohead of nuclear medicine and molecular imaging at Hospital Universitario La Luz, recognizes the importance of emphasizing two aspects of this disease and which have also been objectified in our environment: theirs low incidence (around 3 cases/100,000 persons/year) and his high mortality rate hospital (around 20%).
According to this expert a pioneer in the introduction of PET imaging in Spain in 1995 it is vital to achieve a fast and safe diagnosticsas we know that delaying the initiation of antibiotic treatment or surgery in indicated cases leads to a worse clinical outcome. “Currently, the modified Duke clinical criteria for the diagnosis of endocarditis, which include the 3 categories of definite, possible, and rejected endocarditis, remain fully valid. PET-CT with fluoro-18-fluorodeoxyglucose [18F]FDG has shown great diagnostic capacity in endocarditis in prosthetic valves, pathological valve uptake has been included as a main criterion in the guidelines of the European Society of Cardiology”, confirms Maldonado.
The use of PET-CT metabolic imaging is indicated in patients with a doubtful diagnosis by conventional means, both when infective endocarditis is suspected in prosthetic valves and in intracardiac devices, with greater possibilities of implantation today, given the increasing longevity of the population, according to Maldonado
As Antonio Maldonado explains, “the ability of the FDG biomarker to fixate on areas with increased metabolic activity, responsible for its wide use in oncology, forms the basis for the detection of cardiovascular infections and inflammation. Initial inflammatory changes include hyperemia, cell migration and proliferation, cytokine release, and increased glycolysis, which underlie the pathophysiology of uptake. [18F]FDG infectious and inflammatory tissue”, says the doctor.
“In addition to prosthetic valves, we can also see infection in other devices such as prosthetic tubes, transcatheter aortic valve implantation (TAVI) or in various prosthetic materials used in hospitals. For infection from implantable electronic cardiac devices, the Duke criteria have very low sensitivity. In the control algorithm designed European Heart Rhythm Associationit is recommended to perform PET-CT with [18F]FDG in different clinical situations, with positive and negative cultures, to study the extent of the disease, the portal of entry or the presence of septic pulmonary embolism,” says Dr. Antonio Maldonado.
“He state-of-the-art PET-CT equipment available at Hospital Universitario La Luz enables the use of qualitative-quantitative criteria of FDG molecular imaging in the diagnosis of bacterial endocarditis, improves test performance, is tool which can be used for assess response to treatment. Its clinical usefulness is based on the joint assessment of a nuclear medicine doctor and a radiologist, which is a common way of working in our hospital,” qualifies the doctor. According to this nuclear medicine specialist, qualitative visual interpretation is based on the detection of various abnormal metabolic patterns that allow for early detection of changes indicative of inflammation/infection. In parallel, various quantitative measurements are used, which provide mathematical parameters that lead more precisely to the diagnosis or non-diagnosis of cardiovascular inflammatory/infectious pathology.
“It is to be expected that the application artificial intelligence algorithms In the coming years, this will mean greater reliability and speed in the diagnosis of these processes, especially with regard to specialists who have to make therapeutic decisions. Only the multidisciplinary work of the different departments involved (cardiology, radiology and nuclear medicine) at La Luz University Hospital allows for an early diagnosis, crucial for making effective clinical decisions that lead to the correct hospital care of these patients,” concludes Dr Antonio Maldonado.
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