Publication: Aportación de la PET-TC con ¹⁸F-FDG en la endocarditis infecciosa sobre válvula protésica y en dispositivos intracardiacos
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2017-02-28
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Universidad Complutense de Madrid
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Abstract
Introducción: La endocarditis infecciosa (EI) es una enfermedad que se conoce desde hace siglos pero a día de hoy sigue siendo un reto diagnóstico para los médicos, quienes diariamente se enfrentan a ella planteándose muchas cuestiones aún sin resolver. Tanto es así, que ni la incidencia ni la mortalidad de la enfermedad han disminuido en los últimos 30 años y a pesar de los grandes avances conseguidos en su diagnóstico y tratamiento sigue siendo una enfermedad con mal pronóstico y elevada mortalidad. El diagnóstico precoz de la enfermedad y la instauración temprana de un tratamiento antibiótico correcto, además de una cirugía precoz, en los casos necesarios, pueden mejorar su pronóstico y disminuir la mortalidad. En los últimos años, ha aumentado la incidencia de la EI sobre válvula protésica (EIVP) y en los dispositivos intracardiacos (EIDIC). Además es en estas situaciones donde la ecocardiografía presenta mayores limitaciones, con menor sensibilidad y especificidad en su diagnóstico. Por este motivo, nuevas herramientas en el campo de la imagen como la tomografía computarizada (TC), la resonancia magnética (RM) o la tomografía por emisión de positrones-tomografía computarizada (PET-TC), intentan contribuir en la valoración de esta enfermedad. Actualmente, estos métodos de imagen están en el punto de mira siendo contemplados por los clínicos como posibles armas diagnósticas en un futuro próximo. No obstante, es necesario realizar estudios con rigor científico para evaluar en profundidad su utilidad, antes de su aprobación para la práctica clínica diaria. Objetivo: Recientemente, han aparecido numerosas referencias bibliográficas que estudian la aportación de la PET-TC con 18F-FDG en el diagnóstico de EI sobre válvulas nativas, válvulas protésicas (VP) y dispositivos intracardiacos (DIC). Hasta el momento, los resultados obtenidos con esta técnica de imagen han sido muy dispares, sin existir aún un consenso basado en criterios uniformes para la interpretación de las imágenes morfo-funcionales proporcionadas por este equipo multimodalidad. Por estos motivos, el objetivo de esta tesis doctoral ha sido conocer la utilidad y aportación que puede tener la PET-TC con 18F-FDG como una nueva técnica de imagen, para el diagnóstico de esta enfermedad y de sus complicaciones extracardiacas; centrando el interés del trabajo en las VP y DIC, circunstancias especiales donde otros métodos de imagen como la ecocardiografía, considerada la técnica de imagen gold standard, parecen tener limitaciones diagnósticas....
Introduction: Although infective endocarditis (IE) has been known for centuries, the disease remains today a diagnostic challenge for physicians, who still face many unresolved issues when dealing with it on a daily basis. So much so, that neither the incidence nor the death rate of the disease have declined over the last 30 years. In spite of the great advances in its diagnosis and treatment, the disease still has a poor prognosis and a high mortality rate. Only the early diagnosis of the disease, together with the early administration of appropriate antibiotic treatment and adequate surgical indication may improve its prognosis and reduce its mortality rate. The incidence of prosthetic valve infective endocarditis and that of intracardiac devices has increased in recent years. Moreover, it is in these scenarios that echocardiography has major limitations, presenting lower sensitivity and specificity diagnostic values. Consequently, new imaging tools such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI) or Positron Emission Tomography-Computed Tomography (PET-CT) are trying to contribute to assess the disease. Currently in the spotlight, these imaging methods are being referred to by clinicians as potential diagnostic tools for the near future. Nevertheless, scientifically rigorous studies need to be conducted in order to further evaluate their usefulness, before approving them for use in daily clinical practice. Aim: Numerous references have recently been published on the study the 18F-FDG PET-CT contribution to the diagnosis of IE on native valves, prosthetic valves and intracardiac devices. So far, results obtained with this imaging technique have been highly diverse. Consensus is yet to emerge on the uniform criteria to interpret morphological and functional imaging provided by this multimodal equipment... On these grounds, the aim of this doctoral thesis was to determine the potential usefulness and contribution of 18F-FDG PET-CT as a new imaging technique to diagnose this disease and its associated extracardiac complications. The main focus of the study were prosthetic valves and intracardiac devices where, due to their particular condition, other imaging methods such as echocardiography, recognized as the gold standard imaging technique, appear to have diagnostic limitations...
Introduction: Although infective endocarditis (IE) has been known for centuries, the disease remains today a diagnostic challenge for physicians, who still face many unresolved issues when dealing with it on a daily basis. So much so, that neither the incidence nor the death rate of the disease have declined over the last 30 years. In spite of the great advances in its diagnosis and treatment, the disease still has a poor prognosis and a high mortality rate. Only the early diagnosis of the disease, together with the early administration of appropriate antibiotic treatment and adequate surgical indication may improve its prognosis and reduce its mortality rate. The incidence of prosthetic valve infective endocarditis and that of intracardiac devices has increased in recent years. Moreover, it is in these scenarios that echocardiography has major limitations, presenting lower sensitivity and specificity diagnostic values. Consequently, new imaging tools such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI) or Positron Emission Tomography-Computed Tomography (PET-CT) are trying to contribute to assess the disease. Currently in the spotlight, these imaging methods are being referred to by clinicians as potential diagnostic tools for the near future. Nevertheless, scientifically rigorous studies need to be conducted in order to further evaluate their usefulness, before approving them for use in daily clinical practice. Aim: Numerous references have recently been published on the study the 18F-FDG PET-CT contribution to the diagnosis of IE on native valves, prosthetic valves and intracardiac devices. So far, results obtained with this imaging technique have been highly diverse. Consensus is yet to emerge on the uniform criteria to interpret morphological and functional imaging provided by this multimodal equipment... On these grounds, the aim of this doctoral thesis was to determine the potential usefulness and contribution of 18F-FDG PET-CT as a new imaging technique to diagnose this disease and its associated extracardiac complications. The main focus of the study were prosthetic valves and intracardiac devices where, due to their particular condition, other imaging methods such as echocardiography, recognized as the gold standard imaging technique, appear to have diagnostic limitations...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Radiología y Medicina Física, leída el 16/11/2015