Limits...
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 MSCT studies in a case of aortic bioprosthetic valve infective endocarditis. MPR reconstructions are shown on the aortic valve plane view (a) and the coronal view on the level of the aortic root (b). Images show a large pseudoaneurysm around the bioprosthetic valve (black arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4195843&req=5

Fig8: Results of MSCT studies in a case of aortic bioprosthetic valve infective endocarditis. MPR reconstructions are shown on the aortic valve plane view (a) and the coronal view on the level of the aortic root (b). Images show a large pseudoaneurysm around the bioprosthetic valve (black arrow)

Mentions: IE is suspected on a prosthetic valve when a mass or recent, partial or complete disinsertion of a prosthetic valve is observed. It is defined on echocardiography as para-valvular regurgitation with or without rocking motion of the prosthetic valve [1]. The echocardiography is normal or inconclusive in about 30 % of cases [21]. Echocardiography is limited by acoustic shadowing, particularly when the anterior peri-arortic area is explored [22]. On MSCT, valve disinsertion presents as a pseudoaneurysm surrounding the prosthetic valve (Figs. 7 and 8). Peri-valvular infiltration is a potential finding but is usually difficult to assess due to metallic artefacts. Vegetations on prosthetic valves are also possible and appear as a mass developing on the borderline between the mobile and the fixed portion of mechanic valves or on the leaflet of bioprosthetic valves. MSCT offers high quality isovolumetric voxels affording the possibility of 3D reconstruction and dynamic assessment of leaflet motion. Fagman et al. [20] compared MSCT with TEE in 27 patients with IE on prosthetic aortic valves and found that MSCT’s diagnostic performance is comparable to TEE in the diagnosis of abscesses or dehiscence and may be a valuable complement in the preoperative evaluation of patients with a prosthetic aortic valve [20]. MSCT identified three more pseudoaneuryms that were not detected by TEE [20]. The main limitations of MSCT are artefacts caused by metal and a lack of functional assessment. Saby et al. [23] showed that adding abnormal fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/CT around a prosthetic valve significantly increased the sensitivity of the modified Duke criteria at admission from 70 % (52–83 %) to 97 % (83–99 %); p = 0.008. These results open up new avenues for functional imaging in IE, and several ongoing studies should highlight the use of nuclear imaging in IE, especially in the case of prosthetic valves.Fig. 7


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 MSCT studies in a case of aortic bioprosthetic valve infective endocarditis. MPR reconstructions are shown on the aortic valve plane view (a) and the coronal view on the level of the aortic root (b). Images show a large pseudoaneurysm around the bioprosthetic valve (black arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig8: Results of MSCT studies in a case of aortic bioprosthetic valve infective endocarditis. MPR reconstructions are shown on the aortic valve plane view (a) and the coronal view on the level of the aortic root (b). Images show a large pseudoaneurysm around the bioprosthetic valve (black arrow)
Mentions: IE is suspected on a prosthetic valve when a mass or recent, partial or complete disinsertion of a prosthetic valve is observed. It is defined on echocardiography as para-valvular regurgitation with or without rocking motion of the prosthetic valve [1]. The echocardiography is normal or inconclusive in about 30 % of cases [21]. Echocardiography is limited by acoustic shadowing, particularly when the anterior peri-arortic area is explored [22]. On MSCT, valve disinsertion presents as a pseudoaneurysm surrounding the prosthetic valve (Figs. 7 and 8). Peri-valvular infiltration is a potential finding but is usually difficult to assess due to metallic artefacts. Vegetations on prosthetic valves are also possible and appear as a mass developing on the borderline between the mobile and the fixed portion of mechanic valves or on the leaflet of bioprosthetic valves. MSCT offers high quality isovolumetric voxels affording the possibility of 3D reconstruction and dynamic assessment of leaflet motion. Fagman et al. [20] compared MSCT with TEE in 27 patients with IE on prosthetic aortic valves and found that MSCT’s diagnostic performance is comparable to TEE in the diagnosis of abscesses or dehiscence and may be a valuable complement in the preoperative evaluation of patients with a prosthetic aortic valve [20]. MSCT identified three more pseudoaneuryms that were not detected by TEE [20]. The main limitations of MSCT are artefacts caused by metal and a lack of functional assessment. Saby et al. [23] showed that adding abnormal fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/CT around a prosthetic valve significantly increased the sensitivity of the modified Duke criteria at admission from 70 % (52–83 %) to 97 % (83–99 %); p = 0.008. These results open up new avenues for functional imaging in IE, and several ongoing studies should highlight the use of nuclear imaging in IE, especially in the case of prosthetic valves.Fig. 7

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