The [99mTc]Tc-HMPAO-labelled white blood cell SPECT/CT as a novel criterion for infective endocarditis diagnosis

Katarzyna Holcman; Andrzej Ząbek; Krzysztof Boczar; Paweł Rubiś; Bogdan Ćmiel; Wojciech Szot; Agnieszka Stępień; Katarzyna Graczyk; Piotr Podolec; Magdalena Kostkiewicz

doi:10.1016/j.ijcard.2024.132545

The [^99mTc]Tc-HMPAO-labelled white blood cell SPECT/CT as a novel criterion for infective endocarditis diagnosis

Int J Cardiol. 2024 Dec 15:417:132545. doi: 10.1016/j.ijcard.2024.132545. Epub 2024 Sep 10.

Affiliations

¹ Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland. Electronic address: katarzyna.holcman@uj.edu.pl.
² Jagiellonian University Medical College, Department of Electrocardiology, John Paul II Hospital, Krakow, Poland.
³ Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland.
⁴ AGH University of Science and Technology, Faculty of Applied Mathematics, Krakow, Poland.
⁵ John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland; Jagiellonian University Medical College, Department of Hygiene and Dietetics, Krakow, Poland.
⁶ Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland.

PMID: 39265788
DOI: 10.1016/j.ijcard.2024.132545

Abstract

Aims: Infective endocarditis (IE) poses a significant clinical challenge, necessitating nuanced diagnostic tools for early and accurate detection. The diagnostic role of the hybrid technique of single-photon emission tomography-computed tomography with technetium-99 m-hexamethylpropyleneamine oxime-labelled leukocytes ([^99mTc]Tc-HMPAO-SPECT/CT) has evolved in recent years. This single-center study assessed whether the recent inclusion in the 2023 European Society of Cardiology modified diagnostic criteria of IE (2023 ESC) of infectious lesions detected with [^99mTc]Tc-HMPAO-SPECT/CT affects their diagnostic performance.

Methods and results: Between 2015 and 2019, we enrolled 205 consecutive adults with suspected IE. All participants underwent [^99mTc]Tc-HMPAO-SPECT/CT scans (370-740 MBq). Scans were deemed positive in the presence of intracardiac abnormal tracer uptake and/or within the cardiac implantable electronic device. Patients were prospectively followed-up for 12 ± 10 months. Local device infection (LDI) or IE was diagnosed in 75 (36.6 %) patients, while 72 (35.1 %) [^99mTc]Tc-HMPAO-SPECT/CT results returned positive. Moreover, extracardiac infectious foci were detected in 25 % of [^99mTc]Tc-HMPAO-SPECT/CT scans. The inclusion of both intracardiac and extracardiac lesions detected with [^99mTc]Tc-HMPAO-SPECT/CT yields significantly higher sensitivity (p = 0.003) and negative predictive value (NPV) (p = 0.009).

Conclusion: The inclusion of [^99mTc]Tc-HMPAO-SPECT/CT into the IE diagnostic work-up improves the appropriate classification of patients. For patients with IE, the extended inclusion of lesions detected with [^99mTc]Tc-HMPAO-SPECT/CT in the ESC 2023 diagnostic criteria significantly improves sensitivity and NPV while reducing potential IE misdiagnoses. This pioneering imaging modality is poised to become an integral component of clinical practice, promising to advance IE diagnosis and management.

Keywords: HMPAO; Infective endocarditis; Radiolabelled leukocyte scintigraphy; SPECT; [(99m)Tc]Tc-HMPAO-SPECT/CT.

MeSH terms

Adult
Aged
Endocarditis* / diagnostic imaging
Female
Follow-Up Studies
Humans
Leukocytes* / metabolism
Male
Middle Aged
Prospective Studies
Radiopharmaceuticals*
Single Photon Emission Computed Tomography Computed Tomography* / methods
Technetium Tc 99m Exametazime*

Substances

Technetium Tc 99m Exametazime
Radiopharmaceuticals