Journal of Clinical Medicine

Research

13 pages, 942 KiB

Open AccessArticle

Usefulness of ¹⁸F-FDG PET/CT in Patients with Cardiac Implantable Electronic Device Suspected of Late Infection

by Giuseppe Rubini, Cristina Ferrari, Domenico Carretta, Luigi Santacroce, Rossella Ruta, Francesca Iuele, Valentina Lavelli, Nunzio Merenda, Carlo D’Agostino, Angela Sardaro and Artor Niccoli Asabella

J. Clin. Med. 2020, 9(7), 2246; https://doi.org/10.3390/jcm9072246 - 15 Jul 2020

Cited by 12 | Viewed by 2906

Abstract

The presence of a cardiovascular implantable electronic device (CIED) can be burdened by complications such as late infections that are associated with significant morbidity and mortality and require immediate and effective treatment. The aim of this study was to evaluate the role of [...] Read more.

The presence of a cardiovascular implantable electronic device (CIED) can be burdened by complications such as late infections that are associated with significant morbidity and mortality and require immediate and effective treatment. The aim of this study was to evaluate the role of ¹⁸F-fluorodeoxyglucose positron-emission tomography/computed tomography (¹⁸F-FDG PET/CT) in patients with suspected CIED infection. Fifteen patients who performed a ¹⁸F-FDG PET/CT for suspicion of CIED infection were retrospectively analyzed; 15 patients, with CIED, that underwent ¹⁸F-FDG PET/CT for oncological reasons, were also evaluated. Visual qualitative analysis and semi-quantitative analysis were performed. All patients underwent standard clinical management regardless ¹⁸F-FDG PET/CT results. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) resulted as 90.91%, 75%, 86.67%, 90.91% and 75% respectively. Maximum standardized uptake values (SUV_max) and semi-quantitative ratio (SQR) were collected and showed differences statistically significant between CIED infected patients and those who were not. Exploratory cut-off values were derived from receiver operating characteristic (ROC) curves for SUV_max (2.56) and SQR (4.15). This study suggests the clinical usefulness of ¹⁸F-FDG PET/CT in patients with CIED infection due to its high sensitivity, repeatability and non-invasiveness. It can help the clinicians in decision making, especially in patients with doubtful clinical presentation. Future large-scale and multicentric studies should be conducted to establish precise protocols about ¹⁸F-FDG PET/CT performance. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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19 pages, 3925 KiB

Open AccessArticle

Diagnostic Value of ¹⁸F-FDG-PET/CT in Patients with FUO

by Stamata Georga, Paraskevi Exadaktylou, Ioannis Petrou, Dimitrios Katsampoukas, Vasilios Mpalaris, Efstratios-Iordanis Moralidis, Kostoula Arvaniti, Christos Papastergiou and Georgios Arsos

J. Clin. Med. 2020, 9(7), 2112; https://doi.org/10.3390/jcm9072112 - 04 Jul 2020

Cited by 13 | Viewed by 3474

Abstract

Conventional diagnostic imaging is often ineffective in revealing the underlying cause in a considerable proportion of patients with fever of unknown origin (FUO). The aim of this study was to assess the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸ [...] Read more.

Conventional diagnostic imaging is often ineffective in revealing the underlying cause in a considerable proportion of patients with fever of unknown origin (FUO). The aim of this study was to assess the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) in patients with FUO. We retrospectively reviewed ¹⁸F-FDG-PET/CT scans performed on 50 consecutive adult patients referred to our department for further investigation of classic FUO. Final diagnosis was based on histopathological and microbiological findings, clinical criteria, or clinical follow-up. Final diagnosis was established in 39/50 (78%) of the patients. The cause of FUO was infection in 20/50 (40%), noninfectious inflammatory diseases in 11/50 (22%), and malignancy in 8/50 (16%) patients. Fever remained unexplained in 11/50 (22%) patients. ¹⁸F-FDG-PET/CT scan substantially contributed to the diagnosis in 70% of the patients, either by identifying the underlying cause of FUO or by directing to the most appropriate site for biopsy. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of ¹⁸F-FDG-PET/CT for active disease detection in patients with FUO were 94.7%, 50.0%, 84.0%, 85.7%, and 75.0%, respectively. In conclusion, whole-body ¹⁸F-FDG-PET/CT is a highly sensitive method for detection of the underlining cause of FUO or for correctly targeting suspicious lesions for further evaluation. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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13 pages, 3065 KiB

Open AccessArticle

Theranostic Designed Near-Infrared Fluorescent Poly (Lactic-co-Glycolic Acid) Nanoparticles and Preliminary Studies with Functionalized VEGF-Nanoparticles

by Michela Varani, Filippo Galli, Gabriela Capriotti, Maurizio Mattei, Rosella Cicconi, Giuseppe Campagna, Francesco Panzuto and Alberto Signore

J. Clin. Med. 2020, 9(6), 1750; https://doi.org/10.3390/jcm9061750 - 05 Jun 2020

Cited by 13 | Viewed by 2286

Abstract

Poly-lactic-co-glycolic acid nanoparticles (PLGA-NPs) were approved by the Food and Drug Administration (FDA) for drug delivery in cancer. The enhanced permeability and retention (EPR) effect drives their accumulation minimizing the side effects of chemotherapeutics. Our aim was to develop a new theranostic tool [...] Read more.

Poly-lactic-co-glycolic acid nanoparticles (PLGA-NPs) were approved by the Food and Drug Administration (FDA) for drug delivery in cancer. The enhanced permeability and retention (EPR) effect drives their accumulation minimizing the side effects of chemotherapeutics. Our aim was to develop a new theranostic tool for cancer diagnosis and therapy based on PLGA-NPs and to evaluate the added value of vascular endothelial growth factor (VEGF) for enhanced tumor targeting. In vitro and in vivo properties of PLGA-NPs were tested and compared with VEGF-PLGA-NPs. Dynamic light scattering (DLS) was performed to evaluate the particle size, polydispersity index (PDI), and zeta potential of both preparations. Spectroscopy was used to confirm the absorption spectra in the near-infrared (NIR). In vivo, in BALB/c mice bearing a syngeneic tumor in the right thigh, intravenously injected PLGA-NPs showed a high target-to-muscle ratio (4.2 T/M at 24 h post-injection) that increased over time, with a maximum uptake at 72 h and a retention of the NPs up to 240 h. VEGF-PLGA-NPs accumulated in tumors 1.75 times more than PLGA-NPs with a tumor-to-muscle ratio of 7.90 ± 1.61 (versus 4.49 ± 0.54 of PLGA-NPs). Our study highlights the tumor-targeting potential of PLGA-NPs for diagnostic and therapeutic applications. Such NPs can be conjugated with proteins such as VEGF to increase accumulation in tumor lesions. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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16 pages, 1366 KiB

Open AccessArticle

Comparison of White Blood Cell Scintigraphy, FDG PET/CT and MRI in Suspected Diabetic Foot Infection: Results of a Large Retrospective Multicenter Study

by Chiara Lauri, Andor W.J.M. Glaudemans, Giuseppe Campagna, Zohar Keidar, Marina Muchnik Kurash, Stamata Georga, Georgios Arsos, Edel Noriega-Álvarez, Giuseppe Argento, Thomas C. Kwee, Riemer H.J.A. Slart and Alberto Signore

J. Clin. Med. 2020, 9(6), 1645; https://doi.org/10.3390/jcm9061645 - 30 May 2020

Cited by 30 | Viewed by 3669

Abstract

Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), ¹⁸F-fluorodeoxyglucose positron [...] Read more.

Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography ((¹⁸F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, p < 0.0001 and 86.2% vs. 67.1%, p = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, p = 0.04 and p = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, p = 0.0009; 80.3% and 87.9% vs. 62.1%, p < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% p < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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10 pages, 991 KiB

Open AccessArticle

Comparison of the Diagnostic Value of MRI and Whole Body ¹⁸F-FDG PET/CT in Diagnosis of Spondylodiscitis

by Corinna Altini, Valentina Lavelli, Artor Niccoli-Asabella, Angela Sardaro, Alessia Branca, Giulia Santo, Cristina Ferrari and Giuseppe Rubini

J. Clin. Med. 2020, 9(5), 1581; https://doi.org/10.3390/jcm9051581 - 22 May 2020

Cited by 17 | Viewed by 4117

Abstract

Spondylodiscitis is a spine infection for which a diagnosis by a magnetic resonance imaging (MRI) is considered the most appropriate imaging technique. The aim of this study was to compare the role of an ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG [...] Read more.

Spondylodiscitis is a spine infection for which a diagnosis by a magnetic resonance imaging (MRI) is considered the most appropriate imaging technique. The aim of this study was to compare the role of an ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and an MRI in this field. For 56 patients with suspected spondylodiscitis for whom MRI and ¹⁸F-FDG PET/CT were performed, we retrospectively analyzed the results. Cohen’s κ was applied to evaluate the agreement between the two techniques in all patients and in subgroups with a different number of spinal districts analyzed by the MRI. Sensitivity, specificity, and accuracy were also evaluated. The agreements of the ¹⁸F-FDG PET/CT and MRI in the evaluation of the entire population, whole-spine MRI, and two-districts MRI were moderate (κ = 0.456, κ = 0.432, and κ = 0.429, respectively). In patients for whom one-district MRI was performed, ¹⁸F-FDG PET/CT and MRI were both positive and completely concordant (κ = 1). We also separately evaluated patients with suspected spondylodiscitis caused by Mycobacterium tuberculosis for whom the MRI and ¹⁸F-FDG PET/CT were always concordant excepting in 2 of the 18 (11%) patients. Sensitivity, specificity, and accuracy of the MRI and ¹⁸F-FDG PET/CT were 100%, 60%, 97%, and 92%, 100%, and 94%, respectively. Our results confirmed the ¹⁸F-FDG PET/CT diagnostic value in the diagnosis of spondylodiscitis is comparable to that of MRI for the entire spine evaluation. This could be considered a complementary technique or a valid alternative to MRI. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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Review

Jump to: Research, Other

24 pages, 13111 KiB

Open AccessReview

Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection

by Nicola Galea, Francesco Bandera, Chiara Lauri, Camillo Autore, Andrea Laghi and Paola Anna Erba

J. Clin. Med. 2020, 9(7), 2237; https://doi.org/10.3390/jcm9072237 - 14 Jul 2020

Cited by 15 | Viewed by 4297

Abstract

Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac [...] Read more.

Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac valve) and the search of secondary systemic complications. Early depiction of local complications or distant embolization has a great impact on patient management and prognosis, as it may induce to aggressive antibiotic treatment or, in more advanced cases, cardiac surgery. In this setting, the multimodality imaging has assumed a pivotal role in the clinical decision making and it requires the physician to be aware of the advantages and disadvantages of each imaging technique. Echocardiography is the first imaging test, but it has several limitations. Therefore, the integration with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) becomes often necessary. Different strategies should be applied depending on whether the infection is suspected or already ascertained, whether located in native or prosthetic valves, in the left or right chambers, or if it involves an implanted cardiac device. In addition, detection of extracardiac IE-related lesions is crucial for a correct management and treatment. The aim of this review is to illustrate strengths and weaknesses of the various methods in the most common clinical scenarios. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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20 pages, 1583 KiB

Open AccessReview

Diabetic Foot Infections: The Diagnostic Challenges

by Chiara Lauri, Antonio Leone, Marco Cavallini, Alberto Signore, Laura Giurato and Luigi Uccioli

J. Clin. Med. 2020, 9(6), 1779; https://doi.org/10.3390/jcm9061779 - 08 Jun 2020

Cited by 27 | Viewed by 7537

Abstract

Diabetic foot infections (DFIs) are severe complications of long-standing diabetes, and they represent a diagnostic challenge, since the differentiation between osteomyelitis (OM), soft tissue infection (STI), and Charcot’s osteoarthropathy is very difficult to achieve. Nevertheless, such differential diagnosis is mandatory in order to [...] Read more.

Diabetic foot infections (DFIs) are severe complications of long-standing diabetes, and they represent a diagnostic challenge, since the differentiation between osteomyelitis (OM), soft tissue infection (STI), and Charcot’s osteoarthropathy is very difficult to achieve. Nevertheless, such differential diagnosis is mandatory in order to plan the most appropriate treatment for the patient. The isolation of the pathogen from bone or soft tissues is still the gold standard for diagnosis; however, it would be desirable to have a non-invasive test that is able to detect, localize, and evaluate the extent of the infection with high accuracy. A multidisciplinary approach is the key for the correct management of diabetic patients dealing with infective complications, but at the moment, no definite diagnostic flow charts still exist. This review aims at providing an overview on multimodality imaging for the diagnosis of DFI and to address evidence-based answers to the clinicians when they appeal to radiologists or nuclear medicine (NM) physicians for studying their patients. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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16 pages, 2186 KiB

Open AccessReview

Imaging Modalities for the Diagnosis of Vascular Graft Infections: A Consensus Paper amongst Different Specialists

by Chiara Lauri, Roberto Iezzi, Michele Rossi, Giovanni Tinelli, Simona Sica, Alberto Signore, Alessandro Posa, Alessandro Tanzilli, Chiara Panzera, Maurizio Taurino, Paola Anna Erba and Yamume Tshomba

J. Clin. Med. 2020, 9(5), 1510; https://doi.org/10.3390/jcm9051510 - 17 May 2020

Cited by 22 | Viewed by 4525

Abstract

Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the [...] Read more.

Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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Other

Jump to: Research, Review

20 pages, 2401 KiB

Open AccessConference Report

The Role of Imaging Techniques to Define a Peri-Prosthetic Hip and Knee Joint Infection: Multidisciplinary Consensus Statements

by Carlo Luca Romanò, Nicola Petrosillo, Giuseppe Argento, Luca Maria Sconfienza, Giorgio Treglia, Abass Alavi, Andor W.J.M. Glaudemans, Olivier Gheysens, Alex Maes, Chiara Lauri, Christopher J. Palestro and Alberto Signore

J. Clin. Med. 2020, 9(8), 2548; https://doi.org/10.3390/jcm9082548 - 06 Aug 2020

Cited by 39 | Viewed by 4648

Abstract

Diagnosing a peri-prosthetic joint infection (PJI) remains challenging despite the availability of a variety of clinical signs, serum and synovial markers, imaging techniques, microbiological and histological findings. Moreover, the one and only true definition of PJI does not exist, which is reflected by [...] Read more.

Diagnosing a peri-prosthetic joint infection (PJI) remains challenging despite the availability of a variety of clinical signs, serum and synovial markers, imaging techniques, microbiological and histological findings. Moreover, the one and only true definition of PJI does not exist, which is reflected by the existence of at least six different definitions by independent societies. These definitions are composed of major and minor criteria for defining a PJI, but most of them do not include imaging techniques. This paper highlights the pros and cons of available imaging techniques—X-ray, ultrasound, computed tomography (CT), Magnetic Resonance Imaging (MRI), bone scintigraphy, white blood cell scintigraphy (WBC), anti-granulocyte scintigraphy, and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), discusses the added value of hybrid camera systems—single photon emission tomography/computed tomography (SPECT/CT), PET/CT and PET/MRI and reports consensus answers on important clinical questions that were discussed during the Third European Congress on Inflammation/Infection Imaging in Rome, December 2019. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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10 pages, 1221 KiB

Open AccessConference Report

Imaging Bacteria with Radiolabelled Probes: Is It Feasible?

by Alberto Signore, Vera Artiko, Martina Conserva, Guillermina Ferro-Flores, Mick M. Welling, Sanjay K. Jain, Søren Hess and Mike Sathekge

J. Clin. Med. 2020, 9(8), 2372; https://doi.org/10.3390/jcm9082372 - 25 Jul 2020

Cited by 24 | Viewed by 3420

Abstract

Bacterial infections are the main cause of patient morbidity and mortality worldwide. Diagnosis can be difficult and delayed as well as the identification of the etiological pathogen, necessary for a tailored antibiotic therapy. Several non-invasive diagnostic procedures are available, all with pros and [...] Read more.

Bacterial infections are the main cause of patient morbidity and mortality worldwide. Diagnosis can be difficult and delayed as well as the identification of the etiological pathogen, necessary for a tailored antibiotic therapy. Several non-invasive diagnostic procedures are available, all with pros and cons. Molecular nuclear medicine has highly contributed in this field by proposing several different radiopharmaceuticals (antimicrobial peptides, leukocytes, cytokines, antibiotics, sugars, etc.) but none proved to be highly specific for bacteria, although many agents in development look promising. Indeed, factors including the number and strain of bacteria, the infection site, and the host condition, may affect the specificity of the tested radiopharmaceuticals. At the Third European Congress on Infection/Inflammation Imaging, a round table discussion was dedicated to debate the pros and cons of different radiopharmaceuticals for imaging bacteria with the final goal to find a consensus on the most relevant research steps that should be fulfilled when testing a new probe, based on experience and cumulative published evidence. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd European Congress on Imaging Infection and Inflammation)

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