IMAGING INFECTION 

The Quarterly Journal of Nuclear Medicine 1999 March;43(1):93-9

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Nuclear medicine imaging of endocarditis

Ivancevic V., Munz D. L.

From the Clinic for Nuclear Medicine University Hospital Charité Humboldt University, Berlin, Germany

Infec­tive endo­car­ditis is a ­serious dis­ease ­which ­requires ­early diag­nosis and ade­quate ­therapy. Ech­o­car­di­og­raphy ­plays a key ­role in diag­nosis and ­follow-up. Sub­acute infec­tive endo­car­ditis, how­ever, is ­often dif­fi­cult to ­prove echoc­ar­di­o­graph­i­cally due to its ­more ­subtle mor­pho­log­ical ­changes. ­Also, ech­o­car­di­og­raphy ­cannot reli­ably dif­fer­en­tiate ­florid veg­e­ta­tions ­from ­residual struc­tural ­changes of the ­affected ­valves in ­cured ­patients. There­fore, scin­tig­raphy of infec­tion and inflam­ma­tion, a func­tional ­imaging pro­ce­dure, has ­been inve-s­ti­gated as a com­ple­men­tary ­tool in diag­nosis and ­follow-up of infec­tive endo­car­ditis. So far, ­results ­obtained ­with Gal­lium-67 scin­tig­raphy are not con­vincing, ­although an improve­ment by ­using ­modern acqui­si­tion tech­niques ­seems pos­sible. Scin­tig­raphy ­with ­Indium-111 ­labelled leu­ko­cytes has an unac­cept­ably low sen­si­tivity, ­which is prob­ably due to the ­small ­number of ­cells ­involved and unfa­vour­able ­imaging char­ac­ter­is­tics of 111In-Tech­ne­tium-99m ­labelled leu­ko­cytes ­have ­been inves­ti­gated in few ­patients, so ­final judge­ment is not yet pos­sible. ­SPECT ­imaging ­might ­enhance the detect­ability of dis­eased ­heart ­valves. Immu­nos­cin­tig­raphy ­with the 99mTc ­labelled anti­gra­nu­lo­cyte anti­body in ­SPECT tech­nique is com­ple­men­tary to ech­o­car­di­og­raphy and ­seems to ­assess the flo­ridity of the under­lying inflam­ma­tory pro­cess. The com­bined use of ­both ­imaging modal­ities ­allows detec­tion of vir­tu­ally all ­cases of sub­acute infec­tive endo­car­ditis. ­SPECT immu­nos­cin­tig­raphy ­with the anti­gra­nu­lo­cyte anti­body ­seems ­useful in ­doubtful ­cases of infec­tive endo­car­ditis, espe­cially, if ech­o­car­di­og­raphy is non­di­ag­nostic and ­valve ­pathology pre-­existing. The ­method may be ­used for ­follow-up and mon­i­toring anti­bi­otic ­therapy.