DOI: 10.1007/s00259-018-4025-0Pages: 1795-1815

Recommendations on nuclear and multimodality imaging in IE and CIED infections

1. University of Pisa, Nuclear Medicine, Department of Translational Research and New Technology in Medicine

2. University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging

3. University of Liège Hospital, CHU Sart Tilman, GIGA-Cardiovascular Sciences, Department of Cardiology

4. Anthea Hospital, Gruppo Villa Maria Care and Research

5. Hospital Universitario San Carlos, Department of Cardiology, Instituto Cardiovascular

6. University Heart Center Zurich, Interventional Cardiology and Cardiac Imaging

7. Bichat-Claude Bernard Hospital, AP-HP, Department of Nuclear Medicine

8. UMR-S 1148, Inserm

9. AKH, Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy

10. “Sapienza” University, Nuclear Medicine Unit, Department of Medical-Surgical Sciences and Translational Medicine

11. University of Twente, Department of Biomedical Photonic Imaging

12. Aix-Marseille University, URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095- IHU - Méditerranée Infection

13. APHM, La Timone Hospital, Cardiology Department

Correspondence to:
Paola Anna Erba



In the latest update of the European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE), imaging is positioned at the centre of the diagnostic work-up so that an early and accurate diagnosis can be reached. Besides echocardiography, contrast-enhanced CT (ce-CT), radiolabelled leucocyte (white blood cell, WBC) SPECT/CT and [18F]FDG PET/CT are included as diagnostic tools in the diagnostic flow chart for IE. Following the clinical guidelines that provided a straightforward message on the role of multimodality imaging, we believe that it is highly relevant to produce specific recommendations on nuclear multimodality imaging in IE and cardiac implantable electronic device infections. In these procedural recommendations we therefore describe in detail the technical and practical aspects of WBC SPECT/CT and [18F]FDG PET/CT, including ce-CT acquisition protocols. We also discuss the advantages and limitations of each procedure, specific pitfalls when interpreting images, and the most important results from the literature, and also provide recommendations on the appropriate use of multimodality imaging.

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  • Accepted: Apr 13, 2018
  • Online: May 24, 2018

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