Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure
Purpose: This study aimed to assess the diagnostic performances of multimodal imaging [i.e., white blood cell single-photon emission computed tomography/CT (99mTc-HMPAO-WBC SPECT/CT) and 18-fluoride-fluorodeoxyglucose positron emission tomography/CT ([18F]FDG PET/CT)] in patients with suspected infe...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:7b4c7d1e30e94073be22d0a0f860d7d02021-12-01T22:23:37ZRole of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure2297-055X10.3389/fcvm.2021.745556https://doaj.org/article/7b4c7d1e30e94073be22d0a0f860d7d02021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.745556/fullhttps://doaj.org/toc/2297-055XPurpose: This study aimed to assess the diagnostic performances of multimodal imaging [i.e., white blood cell single-photon emission computed tomography/CT (99mTc-HMPAO-WBC SPECT/CT) and 18-fluoride-fluorodeoxyglucose positron emission tomography/CT ([18F]FDG PET/CT)] in patients with suspected infection after the Bentall procedure, proposing new specific diagnostic criteria for the diagnosis.Methods: Between January 2009 and December 2019, we selected within a cardiovascular infections registry, 76 surgically treated patients (27 women and 49 men, median 66 years, and range 29–83 years). All the patients underwent molecular imaging for a suspected infection after the replacement of the aortic valve and ascending aorta according to the Bentall procedure. We analyzed 98 scans including 49 99mTc-WBC and 49 [18F]FDG PET/CT. A total of 22 patients with very early/early suspected infection (<3 months after surgery) were imaged with both the techniques. Positive imaging was classified according to the anatomical site of increased uptake: to the aortic valve (AV), to both the AV and AV tube graft (AVTG) or to the TG, to surrounding tissue, and/or to extracardiac sites (embolic events or other sites of concomitant infection). Standard clinical workup included in all the patients having echocardiography/CT, blood culture, and the Duke criteria. Pretest probability and positive/negative likelihood ratio were calculated. Sensitivity and specificity of 99mTc labeled hexamethylpropylene amine oxime-WBC SPECT/CT (99mTc-HMPAO-WBC SPECT/CT) and [18F]FDG PET/CT imaging were calculated by using microbiology (n = 35) or clinical follow-up (n = 41) as final diagnosis. 99mTc-HMPAO-WBC scintigraphy and [18F]FDG PET/CT findings were compared with 95% CIs by using the McNemar test to those of echocardiography/CT, blood culture, and the Duke criteria.Results: Sensitivity, specificity, and accuracy of 99mTc-HMPAO-WBC were 86, 92, and 88%, respectively, with a slightly higher sensitivity for tube graft infection (TGI) as compared to isolated AV and combined AVTG. Overall, sensitivity, specificity, and accuracy of [18F]FDG PET/CT were 97, 73, and 90%, respectively. In 22 patients with suspected very early and early postsurgical infections, the two imaging modalities were concordant in 17 cases [10 true positive (TP) and 7 true negative (TN)]. [18F]FDG PET/CT presented a higher sensitivity than 99mTc-HMPAO-WBC scan. 99mTc-HMPAO-WBC scan correctly classified as negative three false-positive (FP) PET/CT findings.Conclusion: Our findings supported the use of 99mTc-HMPAO-WBC SPECT/CT and [18F]FDG PET/CT in patients with suspicion infection after the Bentall procedure early in the course of the disease onset to confirm the diagnosis and provide a comprehensive assessment of disease burden through the proposed criteria.Martina SolliniMartina SolliniFrancesco BartoliRoberto BoniRoberta ZancaAndrea ColliMaurizio LevantinoFrancesco MenichettiMauro FerrariRaffaella BerchiolliElena LazzeriPaola A. ErbaPaola A. ErbaFrontiers Media S.A.articleinfectionmultimodal imagingBentall procedureSPECT/CTPET/CTnuclear medicineDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
infection multimodal imaging Bentall procedure SPECT/CT PET/CT nuclear medicine Diseases of the circulatory (Cardiovascular) system RC666-701 |
| spellingShingle |
infection multimodal imaging Bentall procedure SPECT/CT PET/CT nuclear medicine Diseases of the circulatory (Cardiovascular) system RC666-701 Martina Sollini Martina Sollini Francesco Bartoli Roberto Boni Roberta Zanca Andrea Colli Maurizio Levantino Francesco Menichetti Mauro Ferrari Raffaella Berchiolli Elena Lazzeri Paola A. Erba Paola A. Erba Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure |
| description |
Purpose: This study aimed to assess the diagnostic performances of multimodal imaging [i.e., white blood cell single-photon emission computed tomography/CT (99mTc-HMPAO-WBC SPECT/CT) and 18-fluoride-fluorodeoxyglucose positron emission tomography/CT ([18F]FDG PET/CT)] in patients with suspected infection after the Bentall procedure, proposing new specific diagnostic criteria for the diagnosis.Methods: Between January 2009 and December 2019, we selected within a cardiovascular infections registry, 76 surgically treated patients (27 women and 49 men, median 66 years, and range 29–83 years). All the patients underwent molecular imaging for a suspected infection after the replacement of the aortic valve and ascending aorta according to the Bentall procedure. We analyzed 98 scans including 49 99mTc-WBC and 49 [18F]FDG PET/CT. A total of 22 patients with very early/early suspected infection (<3 months after surgery) were imaged with both the techniques. Positive imaging was classified according to the anatomical site of increased uptake: to the aortic valve (AV), to both the AV and AV tube graft (AVTG) or to the TG, to surrounding tissue, and/or to extracardiac sites (embolic events or other sites of concomitant infection). Standard clinical workup included in all the patients having echocardiography/CT, blood culture, and the Duke criteria. Pretest probability and positive/negative likelihood ratio were calculated. Sensitivity and specificity of 99mTc labeled hexamethylpropylene amine oxime-WBC SPECT/CT (99mTc-HMPAO-WBC SPECT/CT) and [18F]FDG PET/CT imaging were calculated by using microbiology (n = 35) or clinical follow-up (n = 41) as final diagnosis. 99mTc-HMPAO-WBC scintigraphy and [18F]FDG PET/CT findings were compared with 95% CIs by using the McNemar test to those of echocardiography/CT, blood culture, and the Duke criteria.Results: Sensitivity, specificity, and accuracy of 99mTc-HMPAO-WBC were 86, 92, and 88%, respectively, with a slightly higher sensitivity for tube graft infection (TGI) as compared to isolated AV and combined AVTG. Overall, sensitivity, specificity, and accuracy of [18F]FDG PET/CT were 97, 73, and 90%, respectively. In 22 patients with suspected very early and early postsurgical infections, the two imaging modalities were concordant in 17 cases [10 true positive (TP) and 7 true negative (TN)]. [18F]FDG PET/CT presented a higher sensitivity than 99mTc-HMPAO-WBC scan. 99mTc-HMPAO-WBC scan correctly classified as negative three false-positive (FP) PET/CT findings.Conclusion: Our findings supported the use of 99mTc-HMPAO-WBC SPECT/CT and [18F]FDG PET/CT in patients with suspicion infection after the Bentall procedure early in the course of the disease onset to confirm the diagnosis and provide a comprehensive assessment of disease burden through the proposed criteria. |
| format |
article |
| author |
Martina Sollini Martina Sollini Francesco Bartoli Roberto Boni Roberta Zanca Andrea Colli Maurizio Levantino Francesco Menichetti Mauro Ferrari Raffaella Berchiolli Elena Lazzeri Paola A. Erba Paola A. Erba |
| author_facet |
Martina Sollini Martina Sollini Francesco Bartoli Roberto Boni Roberta Zanca Andrea Colli Maurizio Levantino Francesco Menichetti Mauro Ferrari Raffaella Berchiolli Elena Lazzeri Paola A. Erba Paola A. Erba |
| author_sort |
Martina Sollini |
| title |
Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure |
| title_short |
Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure |
| title_full |
Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure |
| title_fullStr |
Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure |
| title_full_unstemmed |
Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure |
| title_sort |
role of multimodal imaging in patients with suspected infections after the bentall procedure |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/7b4c7d1e30e94073be22d0a0f860d7d0 |
| work_keys_str_mv |
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