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Cardiac multidetector computed tomography in infective endocarditis: a pictorial essay.

Grob A, Thuny F, Villacampa C, Flavian A, Gaubert JY, Raoult D, Casalta JP, Habib G, Moulin G, Jacquier A - Insights Imaging (2014)

Bottom Line: Extra-cardiac location could involve all organs.MSCT can be considered as a useful complement in visualising the cardiac lesions of IE if echocardiography is inconclusive.MSCT is the only imaging modality that provides assessment of valvular and peri-valvular involvement, extra-cardiac lesions, and non-invasive evaluation of the coronary artery anatomy, simultaneously. • MSCT provides assessment of coronary anatomy, cardiac and extra-cardiac lesions. • MSCT represents an alternative to echocardiography during IE. • Surgical valve replacement is usually required if vegetation is >10 mm. • Peri-valvular extension (abscesses, pseudoaneurysm and fistulae) required surgical treatment.

View Article: PubMed Central - PubMed

Affiliation: Service de Radiologie Adultes, Centre Hospitalier Universitaire Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.

ABSTRACT

Objectives: The goals of this pictorial essay are: (1) to set out a multislice computed tomography (MSCT) imaging protocol to assess infective endocarditis (IE); (2) to give an MSCT overview of valvular and peri-valvular involvement during IE; (3) to give a CT overview of septic embolism and infectious pseudoaneurysms during IE.

Methods: MSCT acquisition protocols to assess IE are performed in two different phases: the first acquisition, under electrocardiography (ECG) gating, covers the cardiac structures during first-pass iodine injection; the second acquisition covers the thorax, abdomen, pelvic and cerebral regions.

Results: Valvular and peri-valvular lesions during IE are: vegetation-a hypodense, homogeneous, irregular mass on a valve or endocardial structure; perforation-a defect in the leaflet; valvular aneurysm-loss of the homogenous curvature of the leaflet; valvular thickening; peri-valvular abscess; pseudoaneurysm; fistula and disinsertion of a prosthetic valve. Extra-cardiac location could involve all organs.

Conclusions: MSCT can be considered as a useful complement in visualising the cardiac lesions of IE if echocardiography is inconclusive. MSCT is the only imaging modality that provides assessment of valvular and peri-valvular involvement, extra-cardiac lesions, and non-invasive evaluation of the coronary artery anatomy, simultaneously.

Main messages: • MSCT provides assessment of coronary anatomy, cardiac and extra-cardiac lesions. • MSCT represents an alternative to echocardiography during IE. • Surgical valve replacement is usually required if vegetation is >10 mm. • Peri-valvular extension (abscesses, pseudoaneurysm and fistulae) required surgical treatment.

No MeSH data available.


Related in: MedlinePlus

Results of echocardiography and MSCT studies in cases of mitral valve IE. Images show four-chamber views in the TEE study (a) and four-chamber view MSCT acquisitions with MPR reconstruction (b). Both TEE and MSCT show a large vegetation (white arrow) and destruction of the mitral valve with substantial dilatation of the left atrium and pericardial effusion
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Fig1: Results of echocardiography and MSCT studies in cases of mitral valve IE. Images show four-chamber views in the TEE study (a) and four-chamber view MSCT acquisitions with MPR reconstruction (b). Both TEE and MSCT show a large vegetation (white arrow) and destruction of the mitral valve with substantial dilatation of the left atrium and pericardial effusion

Mentions: Vegetations consist of a mass of soft tissue composed of platelets, fibrin, inflammatory cells and microorganisms. They are defined on echocardiography as an oscillating or non-oscillating mass attached to a valve or other endocardial structure or on implanted intracardiac material [1]. On MSCT, vegetations can appear as a thickened valve or as irregular, homogenous, hypodense masses attached to the valve or other endocardial structures (Fig. 1, Table 3). Vegetations are mobile during the cardiac cycle and develop frequently on the atrial site of the mitral valve and on the ventricular side of the aortic valve. The migration of these vegetations explains the embolic events that occur during IE. MSCT can play a role in predicting embolic events; several factors are associated with increased risk of embolism including size and mobility, location on the mitral valve, change in size under therapy, type of microorganism (staphylococci, Streptococcus bovis, Candida spp.) previous embolism, multivalvular IE. Among these, size and mobility are the most potent independent predictors of an embolic event [1]. The risk of embolism increases with large vegetations (>10 mm) and is particularly high with very mobile and larger vegetations (>15 mm). Vegetation size is defined by the maximal length of its three spatial dimensions. The valve may require surgical replacement if the vegetation is >10 mm (Table 4) [14]. There is a strong correlation between the size of vegetations seen on MSCT and echocardiography [7]. Different studies show that 100 % of the vegetations >10 mm are diagnosed by MSCT [15]. The sensitivity of echocardiography in detecting vegetations is around 75 % for TTE and 85-90 % for TEE [16]. Feuchtner et al. [7] showed that the sensitivity and specificity of MSCT in detecting leaflet vegetation was comparable to TEE (i.e. 96 % and 97 % respectively) using intraoperative surgical findings as a standard of reference. The diagnosis may be difficult on MSCT when there are pre-existing degenerative calcified lesions of the valve and when the vegetations are less than 2 mm high [17]. Differential diagnoses for valvular vegetations are mainly prosthetic valvular thrombi and fibroelastomas.Fig. 1


Cardiac multidetector computed tomography in infective endocarditis: a pictorial essay.

Grob A, Thuny F, Villacampa C, Flavian A, Gaubert JY, Raoult D, Casalta JP, Habib G, Moulin G, Jacquier A - Insights Imaging (2014)

Results of echocardiography and MSCT studies in cases of mitral valve IE. Images show four-chamber views in the TEE study (a) and four-chamber view MSCT acquisitions with MPR reconstruction (b). Both TEE and MSCT show a large vegetation (white arrow) and destruction of the mitral valve with substantial dilatation of the left atrium and pericardial effusion
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195843&req=5

Fig1: Results of echocardiography and MSCT studies in cases of mitral valve IE. Images show four-chamber views in the TEE study (a) and four-chamber view MSCT acquisitions with MPR reconstruction (b). Both TEE and MSCT show a large vegetation (white arrow) and destruction of the mitral valve with substantial dilatation of the left atrium and pericardial effusion
Mentions: Vegetations consist of a mass of soft tissue composed of platelets, fibrin, inflammatory cells and microorganisms. They are defined on echocardiography as an oscillating or non-oscillating mass attached to a valve or other endocardial structure or on implanted intracardiac material [1]. On MSCT, vegetations can appear as a thickened valve or as irregular, homogenous, hypodense masses attached to the valve or other endocardial structures (Fig. 1, Table 3). Vegetations are mobile during the cardiac cycle and develop frequently on the atrial site of the mitral valve and on the ventricular side of the aortic valve. The migration of these vegetations explains the embolic events that occur during IE. MSCT can play a role in predicting embolic events; several factors are associated with increased risk of embolism including size and mobility, location on the mitral valve, change in size under therapy, type of microorganism (staphylococci, Streptococcus bovis, Candida spp.) previous embolism, multivalvular IE. Among these, size and mobility are the most potent independent predictors of an embolic event [1]. The risk of embolism increases with large vegetations (>10 mm) and is particularly high with very mobile and larger vegetations (>15 mm). Vegetation size is defined by the maximal length of its three spatial dimensions. The valve may require surgical replacement if the vegetation is >10 mm (Table 4) [14]. There is a strong correlation between the size of vegetations seen on MSCT and echocardiography [7]. Different studies show that 100 % of the vegetations >10 mm are diagnosed by MSCT [15]. The sensitivity of echocardiography in detecting vegetations is around 75 % for TTE and 85-90 % for TEE [16]. Feuchtner et al. [7] showed that the sensitivity and specificity of MSCT in detecting leaflet vegetation was comparable to TEE (i.e. 96 % and 97 % respectively) using intraoperative surgical findings as a standard of reference. The diagnosis may be difficult on MSCT when there are pre-existing degenerative calcified lesions of the valve and when the vegetations are less than 2 mm high [17]. Differential diagnoses for valvular vegetations are mainly prosthetic valvular thrombi and fibroelastomas.Fig. 1

Bottom Line: Extra-cardiac location could involve all organs.MSCT can be considered as a useful complement in visualising the cardiac lesions of IE if echocardiography is inconclusive.MSCT is the only imaging modality that provides assessment of valvular and peri-valvular involvement, extra-cardiac lesions, and non-invasive evaluation of the coronary artery anatomy, simultaneously. • MSCT provides assessment of coronary anatomy, cardiac and extra-cardiac lesions. • MSCT represents an alternative to echocardiography during IE. • Surgical valve replacement is usually required if vegetation is >10 mm. • Peri-valvular extension (abscesses, pseudoaneurysm and fistulae) required surgical treatment.

View Article: PubMed Central - PubMed

Affiliation: Service de Radiologie Adultes, Centre Hospitalier Universitaire Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.

ABSTRACT

Objectives: The goals of this pictorial essay are: (1) to set out a multislice computed tomography (MSCT) imaging protocol to assess infective endocarditis (IE); (2) to give an MSCT overview of valvular and peri-valvular involvement during IE; (3) to give a CT overview of septic embolism and infectious pseudoaneurysms during IE.

Methods: MSCT acquisition protocols to assess IE are performed in two different phases: the first acquisition, under electrocardiography (ECG) gating, covers the cardiac structures during first-pass iodine injection; the second acquisition covers the thorax, abdomen, pelvic and cerebral regions.

Results: Valvular and peri-valvular lesions during IE are: vegetation-a hypodense, homogeneous, irregular mass on a valve or endocardial structure; perforation-a defect in the leaflet; valvular aneurysm-loss of the homogenous curvature of the leaflet; valvular thickening; peri-valvular abscess; pseudoaneurysm; fistula and disinsertion of a prosthetic valve. Extra-cardiac location could involve all organs.

Conclusions: MSCT can be considered as a useful complement in visualising the cardiac lesions of IE if echocardiography is inconclusive. MSCT is the only imaging modality that provides assessment of valvular and peri-valvular involvement, extra-cardiac lesions, and non-invasive evaluation of the coronary artery anatomy, simultaneously.

Main messages: • MSCT provides assessment of coronary anatomy, cardiac and extra-cardiac lesions. • MSCT represents an alternative to echocardiography during IE. • Surgical valve replacement is usually required if vegetation is >10 mm. • Peri-valvular extension (abscesses, pseudoaneurysm and fistulae) required surgical treatment.

No MeSH data available.


Related in: MedlinePlus