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    Molecular Imaging of Cardiovascular Device Infection: Targeting the Bacteria or the Host-Pathogen Immune Response?

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    Author
    Chen, W.
    Dilsizian, V.
    Date
    2020
    Journal
    Journal of nuclear medicine : official publication, Society of Nuclear Medicine
    Publisher
    Society of Nuclear Medicine, Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.2967/jnumed.119.228304
    Abstract
    Rapid and accurate diagnosis of cardiovascular device infection remains a challenge in the clinic. Anatomic imaging tools such as echocardiography and cardiac CT or CT angiography are the first-line modalities for clinically suspected endocarditis given their ability to detect vegetation and perivalvular complications. Accumulating data suggest that functional imaging with 18F-FDG PET/CT has unique merits over anatomic imaging and could potentially diagnose early cardiac device infection before morphologic damage ensues and identify infection sources or bacterial emboli in the rest of the body. Although an abnormal finding on 18F-FDG PET/CT was added to the 2015 guidelines of the European Society of Cardiology as a major criterion for the diagnosis of device-related and prosthetic valve endocarditis, that addition has not been incorporated in the U.S. guidelines. Beyond these clinically available imaging tools, attempts have been made to develop bacteria-targeting tracers for specific infection imaging, which include tracers of bacterial maltodextrin transporter, bacterial thymidine kinase, antibiotics, antimicrobial peptides, bacterial antibodies, bacteriophages, and bacterial DNA/RNA hybrid nucleotide oligomers. Most of the tracers have been studied only in experimental animals, except for radiolabeled antibiotics, which have been examined in humans without success in clinical translation for infection imaging. In this article, we compare the roles of anatomic and functional imaging for cardiac device infection and discuss the pros and cons of 18F-FDG and bacteria-targeting tracers. While anticipating continued investigations for bacteria-specific tracers in the future, we recommend that 18F-FDG PET/CT, which represents the host-pathogen immune response to infection, be used clinically for identifying cardiovascular device infection.
    Keyword
    bacteria
    cardiovascular device
    FDG
    infection
    maltodextrin transporter
    PET/CT
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081135798&doi=10.2967%2fjnumed.119.228304&partnerID=40&md5=dcc25ecaaac35e00d49989964b2e0d23; http://hdl.handle.net/10713/12311
    ae974a485f413a2113503eed53cd6c53
    10.2967/jnumed.119.228304
    Scopus Count
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    UMB Open Access Articles 2020

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