Gallium-68 FAPI PET-CT and FDG PET-CT imaging successfully identified stent-related infections and infective endocarditis in all six patients, influencing clinical management without the need for surgical intervention.
Does nuclear medicine imaging (FDG and FAPI PET-CT) improve the localization and diagnosis of suspected cardiac infections in patients with stents, endocarditis, or CIEDs?
Ga-68 FAPI PET-CT is a promising imaging modality for diagnosing cardiac infections, overcoming the limitations of FDG PET-CT by not requiring prolonged fasting or strict blood sugar control.
Infections in relation to the heart could be localised, as in a mycotic aneurysm, or systemic (as in infective endocarditis with septicemia). Echocardiography remains a mainstay in diagnosing native valve endocarditis. However, it has limitations in prosthetic valve endocarditis. An infected cardiac device is another challenge for direct visualisation of the focus of infection, and computed tomography (CT) and magnetic resonance imaging have limited application other than the detection of structural changes such as an aneurysm. Fluorine 18-fluorodeoxyglucose positron emission tomography-computed tomography is a sensitive tool to detect a focus of infection/inflammation, but its use in detecting myocardial inflammation involves stringent preparations such as prolonged fasting and preadministration of heparin. Gallium-68-fibrinogen activation protein inhibitor is a recently introduced molecule which overcomes this difficulty, as it does not show any uptake in the normal heart. It does not require fasting status or stringent control of blood sugar. It does localise to the site of infarction, and there is limited literature related to its use in infections involving the heart. This report presents six cases with clinical suspicion of infections involving stents, the endocardium, and cardiac implantable electronic devices, where nuclear medicine procedures played a crucial role in influencing the diagnosis.
Solav et al. (Tue,) conducted a other in Cardiac infections (n=6). Gallium-68-fibroblast activation protein inhibitor (FAPI) PET-CT and Fluorine18-fluorodeoxyglucose (FDG) PET-CT vs. Not applicable (No direct comparator as this is a case series) was evaluated on Detection of cardiac infections using nuclear medicine procedures. Gallium-68 FAPI PET-CT and FDG PET-CT imaging successfully identified stent-related infections and infective endocarditis in all six patients, influencing clinical management without the need for surgical intervention.