This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.

中文翻译：

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18F-FDG PET/CT 和放射性标记白细胞 SPECT/CT 成像用于评估多模态心血管感染：ASNC 成像适应症 (ASNC I2) 系列专家共识建议，来自 ASNC、AATS、ACC、AHA、ASE、EANM、HRS、 IDSA、SCCT、SNMMI 和 STS

这份关于心血管感染（包括感染性心内膜炎）的文件是美国核心脏病学影像适应症学会 (ASNC I2) 系列中的第一份文件，旨在评估放射性核素成像在多模态背景下评估多社会参与的复杂全身性疾病的作用包括相关学科。采用严格的改良德尔菲法来确定共识临床适应症、诊断标准和诊断心血管感染（包括感染性心内膜炎）的算法方法。心血管感染的发病率正在增加，并且与高发病率和死亡率相关。当前基于临床标准和初始超声心动图成像方法的策略是有效的，但在复杂的心血管感染中往往不够。采用 18F-氟脱氧葡萄糖 (FDG) 正电子发射断层扫描/计算机断层扫描 (PET/CT) 和单光子发射计算机断层扫描/CT 白细胞闪烁扫描的放射性核素成像可以通过提高诊断准确性、识别心外受累和评估心脏来增强对可疑心血管感染的评估植入的装置袋、导线和心室辅助装置的所有部分。这种先进的成像技术可以帮助解决关键的医疗和手术问题。共识诊断特征包括瓣膜和假体材料、瓣周区域、装置袋和引线以及心室辅助装置硬件上持续存在非衰减校正图像的局灶/多灶或弥漫性异质强烈 18F-FDG 摄取。有许多临床适应症在人工瓣膜和心脏装置中发挥着更大的作用，特别是在可能存在感染性心内膜炎或先前模棱两可或非诊断性影像的情况下。包含这些共识建议的说明性案例提供了额外的说明。未来的研究有必要完善这些先进成像工具在手术规划中的应用，以确定治疗反应等。