CME 7 Session - EANM'16

Cardiovascular/Inflammation & Infection/EACVI: Imaging Sarcoidosis, Endocarditis and Amyloidosis by PET

Educational objectives:
  1. What is the most optimal patient preparation for18F-FDG PET/CT in patients suspected for having infective endocarditis?
  2. What are the possible pitfalls when interpreting 18F-FDG PET/CT in patients suspected for having infective endocarditis?
  3. How to ass cardiac sarcoidosis with 18F-FDG and other (PET) tracers
  4. How to ass cardiac amyloidosis with (non-)PET tracers, echo, CT and MRI

This CME on myocardial infection/inflammation (i.e. endocarditis, sarcoidosis and amyloidosis) has an emphasis on the multidisciplinary approach and has a primary focus on the imaging with nuclear medicine techniques.

Infective endocarditis (IE) is a deadly disease. Despite improvements in its management, IE remains associated with high mortality and severe complications. The diagnosis of IE is challenging and the evaluation of patients with IE is no longer limited to conventional echocardiography, but should include several other imaging techniques such as 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) or other functional imaging modalities. However adequate patient preparation is essential as this may prevent possible artifacts.1

Sarcoidosis is a multisystem disease of unknown aetiology. Cardiac sarcoidosis (CS) has a poor prognosis because of the frequently occurring atrioventricular block (AVB), ventricular tachycardia (VT), and congestive heart failure. Therefore an accurate and early diagnosis is essential so that anti-inflammatory therapy can be initiated and adverse outcomes prevented. Studies have demonstrated the usefulness of 18F-FDGPET in the diagnosis of CS.2

Amyloidosis is characterized by depositions of amyloid in organs and tissues. Cardiac amyloidosis is a debilitating disease and can lead to arrhythmias, deterioration of heart function and even sudden death. There are several possibilities to evaluate myocardial amyloid involvement. Although PET tracers have the possible advantage of absolute quantification and higher resolution, these tracers are not sufficiently evaluated yet. Therefore there is still the need for further research in this field.3

Key Words:

Infective Endocarditis, Cardiac Sarcoidosis, Cardiac Amyloidosis



1.  Lancellotti P et al. ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2015;36:3075–3123.

2.  Ohira H et al. Comparison of (18)F-fluorodeoxyglucose positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) in corticosteroid-naive patients with conduction system disease due to cardiac sarcoidosis. Eur J Nucl Med Mol Imaging. 2016;43:259-269.

3.  Glaudemans A et al. Nuclear imaging in cardiac amyloidosis. Eur J Nucl Med Mol Imaging. 2009;36:702-714. 

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