Molecular Imaging of Cardiovascular Device Infection

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 0.25
Procedures: 0.25
Diagnostic and Conduction System Studies: 0.25

Computed Tomography: 0.50
Procedures: 0.50
Neck and Chest: 0.50

Nuclear Medicine Technology: 1.75
Procedures: 1.75
Other Imaging Procedures: 1.75

Registered Radiologist Assistant: 1.75
Procedures: 1.75
Thoracic Section: 1.75

Outline

1. Introduction
2. Anatomic Imaging Tools
3. Functional Imaging Tools
4. Bacteria-Targeting Tracers
   1. Bacterial Metabolic Substances
   2. Antibiotics
   3. Antimicrobial Peptides
   4. Bacterial Antibodies
   5. Bacteriophages and Bacterial DNA/RNA Hybrid Nucleotide Oligomers
5. Considerations of ¹⁸F-FDG and Bacteria-Targeting Tracers for Infection Imaging
6. Technical Challenges for Bacteria-Targeting PET Tracers
   1. Bile Duct Stricture
7. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with anatomically based modalities for detecting cardiovascular device infection
2. be familiar with functionally based modalities for detecting cardiovascular device infection
3. be familiar with the issues surrounding metal ring-related acoustic shadowing artifact on transesophageal echocardiography
4. identify the imaging modalities that demonstrate late morphologic changes and have findings that are often nonspecific and associated with device related artifacts
5. be familiar with how ¹⁸F-FDG PET/CT can affect the management of patients with clinically suspected endocarditis
6. be familiar with the imaging modalities that have been accepted in the U.S. for detection of cardiac device infection
7. be familiar with the lack of clinical translation of ^99mTc-ciproflozacin as a radiotracer for detection of infection
8. be familiar with ¹⁸F-labeled maltodextrin tracers being studied for infection detection
9. identify the pharmacokinetic features that make ¹⁸F-maltotriose a promising radiotracer for infection imaging
10. be familiar with the characteristics of ¹¹¹In WBC SPECT/CT for cardiac device infection imaging
11. be familiar with first line imaging modalities for infective endocarditis
12. be familiar with nucleoside radiotracers for infection detection
13. be familiar with the limitation of ^99mTc-ciproflozacin as a radiotracer for detection of infection
14. be familiar with antimicrobial peptides used for bacterial infection imaging
15. be familiar with the radionuclides used to label antimicrobial peptides for infection imaging
16. recognize the limitations of radiolabeled antibodies for bacterial infection imaging
17. identify organizations recommending ¹⁸F-FDG PET/CT for diagnosis of cardiac device-related and prosthetic valve endocarditis
18. be familiar with methods to address nonspecific accumulation of ¹⁸F FDG PET/CT
19. be familiar with the limited use of ¹⁸F-FDG PET/CT for cardiac device infection in the U.S.
20. understand what a negative¹⁸F-FDG PET/CT represents in patients with suspected cardiac device infection
21. understand the effects of antibiotics on bacterial radiotracer imaging
22. be familiar with the method of excretion for ¹⁸F-maltose
23. be familiar with the MDT radiotracer that holds the most promise for imaging infection in a clinical setting
24. identify the target of ¹⁸F-FDG PET/CT imaging
25. be familiar with the radiotracers for infection imaging studied in humans
26. identify the bacterial radiotracers that target DNA gyrase
27. be familiar with the main findings surrounding studies conducted with antimicrobial peptides
28. be familiar with the biofilm formation associated with cardiac device infection
29. recognize the reasons for lower sensitivity found in the use of most bacterial radiotracers
30. be familiar with the use ¹⁸F-FDG PET/CT in detecting cardiac device infection