{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T19:14:40Z","timestamp":1774120480352,"version":"3.50.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Purpose:<\/jats:bold> This study aimed to assess the diagnostic performances of multimodal imaging [i.e., white blood cell single-photon emission computed tomography\/CT (<jats:sup>99m<\/jats:sup>Tc-HMPAO-WBC SPECT\/CT) and 18-fluoride-fluorodeoxyglucose positron emission tomography\/CT ([<jats:sup>18<\/jats:sup>F]FDG PET\/CT)] in patients with suspected infection after the Bentall procedure, proposing new specific diagnostic criteria for the diagnosis.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Between January 2009 and December 2019, we selected within a cardiovascular infections registry, 76 surgically treated patients (27 women and 49 men, median 66 years, and range 29\u201383 years). All the patients underwent molecular imaging for a suspected infection after the replacement of the aortic valve and ascending aorta according to the Bentall procedure. We analyzed 98 scans including 49 <jats:sup>99m<\/jats:sup>Tc-WBC and 49 [<jats:sup>18<\/jats:sup>F]FDG PET\/CT. A total of 22 patients with very early\/early suspected infection (&amp;lt;3 months after surgery) were imaged with both the techniques. Positive imaging was classified according to the anatomical site of increased uptake: to the aortic valve (AV), to both the AV and AV tube graft (AVTG) or to the TG, to surrounding tissue, and\/or to extracardiac sites (embolic events or other sites of concomitant infection). Standard clinical workup included in all the patients having echocardiography\/CT, blood culture, and the Duke criteria. Pretest probability and positive\/negative likelihood ratio were calculated. Sensitivity and specificity of <jats:sup>99m<\/jats:sup>Tc labeled hexamethylpropylene amine oxime-WBC SPECT\/CT (<jats:sup>99m<\/jats:sup>Tc-HMPAO-WBC SPECT\/CT) and [<jats:sup>18<\/jats:sup>F]FDG PET\/CT imaging were calculated by using microbiology (<jats:italic>n<\/jats:italic> = 35) or clinical follow-up (<jats:italic>n<\/jats:italic> = 41) as final diagnosis. <jats:sup>99m<\/jats:sup>Tc-HMPAO-WBC scintigraphy and [<jats:sup>18<\/jats:sup>F]FDG PET\/CT findings were compared with 95% CIs by using the McNemar test to those of echocardiography\/CT, blood culture, and the Duke criteria.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Sensitivity, specificity, and accuracy of <jats:sup>99m<\/jats:sup>Tc-HMPAO-WBC were 86, 92, and 88%, respectively, with a slightly higher sensitivity for tube graft infection (TGI) as compared to isolated AV and combined AVTG. Overall, sensitivity, specificity, and accuracy of [<jats:sup>18<\/jats:sup>F]FDG PET\/CT were 97, 73, and 90%, respectively. In 22 patients with suspected very early and early postsurgical infections, the two imaging modalities were concordant in 17 cases [10 true positive (TP) and 7 true negative (TN)]. [<jats:sup>18<\/jats:sup>F]FDG PET\/CT presented a higher sensitivity than <jats:sup>99m<\/jats:sup>Tc-HMPAO-WBC scan. <jats:sup>99m<\/jats:sup>Tc-HMPAO-WBC scan correctly classified as negative three false-positive (FP) PET\/CT findings.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Our findings supported the use of <jats:sup>99m<\/jats:sup>Tc-HMPAO-WBC SPECT\/CT and [<jats:sup>18<\/jats:sup>F]FDG PET\/CT in patients with suspicion infection after the Bentall procedure early in the course of the disease onset to confirm the diagnosis and provide a comprehensive assessment of disease burden through the proposed criteria.<\/jats:p>","DOI":"10.3389\/fcvm.2021.745556","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T22:23:45Z","timestamp":1638397425000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Role of Multimodal Imaging in Patients With Suspected Infections After 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