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This editorial refers to ‘Simultaneous dual-isotope solid-state detector single photon emission computed tomography for improved tracking of white blood cells in suspected endocarditis’†, by F. Caobelli et al., on page 436.

The non-invasive diagnosis of infective endocarditis (IE) relies mainly on the combination of morphological evidence of infection on native or prosthetic valves, and identification of an infective agent on blood culture.1 However, in the absence of morphological changes suggestive of endocarditis detectable on echocardiography, the diagnosis based on the probabilistic Duke criteria may remain undetermined. In recent years, nuclear techniques such as [18F]fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and white blood cell (WBC) single photon emission computed tomography (SPECT)/CT were successfully applied to IE. In particular, in the case of suspicion of prosthetic valve infection, when artefacts generated by composite components affect the reliability of morphological imaging by ultrasound or CT, the functional approach proved useful. As a result, nuclear techniques have been included in the recently issued European Society of Cardiology (ESC) guidelines for the diagnosis strategy in patients with suspicion of prosthetic valve endocarditis.2 The specific insight allowed by nuclear techniques is due to their ability to target host response to infection: increased metabolic activity of cells involved in the innate and adaptative immune system with 18FDG PET, or leucocyte recruitment secondary to the release of chemotactic mediators by inflammatory cells with WBC SPECT. The latter proved to be highly specific of infection, with a somewhat lower sensitivity.3–5

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Clinical Research
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