Nuklearmedizinische Bildgebung bei infektiöser Endokarditis und Device-Infektionen

Zusammenfassung

Die infektiöse Endokarditis (IE) stellt eine lebensbedrohende Erkrankung dar. Aufgrund der zunehmenden Zahl kardialer Eingriffe und Implantate steigen die Endokarditisfälle. Die Diagnose der infektiösen Endokarditis ist komplex und wird anhand der Klinik, der Mikrobiologie und der Bildgebung gestellt. Nach einer Überarbeitung der ESC-Leitlinie zur Endokarditis wurden die ¹⁸F-FDG-PET-CT und die Leukozyten-SPECT-CT in den diagnostischen Algorithmus der Endokarditis-Diagnostik aufgenommen. Indikationen bestehen beim Verdacht auf eine Protheseninfektion und zusätzlich bei der Suche nach septischen Thrombembolien. Der Benefit der nuklearmedizinischen Diagnostik liegt in einer deutlichen Verringerung der IE-Verdachtsdiagnosen und einer zuverlässigeren Zuordnung in die Kategorien „IE sicher“ bzw. „IE ausgeschlossen“.

Darüber hinaus eignet sich die ¹⁸F-FDG-PET-CT für die Diagnostik von Schrittmacherinfektionen, Sondenbeteiligungen und die Entzündungslokalisation bei kardialen Unterstützungssystemen.

Die nuklearmedizinische Bildgebung bei Endokarditis erfordert eine spezielle Patientenvorbereitung und die Kenntnis spezifischer Pitfalls, die sich durch die Absorptionskorrektur und die physiologische Reaktion auf das Fremdkörpermaterial ergeben.

Abstract

Infective endocarditis (IE) is a life-threatening disease. Due to increasing numbers of diagnostic and therapeutic procedures as well as cardiac device implantations, the prevalence of IE is rising. The diagnosis of IE is complex and based on clinical findings, microbiology, and imaging. After a revision of the ESC endocarditis guideline in 2015, ¹⁸F-FDG-PET-CT and the leukocytes SPECT-CT were included in the diagnostic algorithm. Indications for nuclear medicine imaging are suspected prosthetic valve infection and the search for septic thrombembolism. The potential benefit of nuclear medicine diagnostics is a significant reduction in the number of uncertain IE diagnoses and a more reliable classification into the categories "definitve IE" or "rejected IE".

In addition, ¹⁸F-FDG-PET-CT is suitable for the diagnosis of pacemaker infections, probe involvement and inflammation localization of infected sites in cardiac assist devices.

Nuclear medicine imaging of IE requires special patient preparation and knowledge of specific pitfalls resulting from attenuation correction and physiological reaction to foreign body material.

Schlüsselwörter

Endokarditis - Diagnostik - ¹⁸F-FDG-PET-CT - Leukozyten-SPECT-CT

Keywords

Endocarditis - diagnosis - ¹⁸F-FDG-PET-CT - leucocyte SPECT-CT

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