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J Nucl Med. 2014 Jul;55(7):1093-8. doi: 10.2967/jnumed.113.134981. Epub 2014 May 8.

Role of (18)F-FDG PET in Patients with Infectious Endocarditis.

Author information

1
Clinical Microbiology Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Department of Medicine, Complutense University, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain pmunoz@micro.hggm.es kestler.martha@gmail.com.
2
Clinical Microbiology Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Department of Medicine, Complutense University, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES), Recinto Hospital Joan March, Bunyola, Spain pmunoz@micro.hggm.es kestler.martha@gmail.com.
3
Clinical Microbiology Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Department of Medicine, Complutense University, Madrid, Spain.
4
Nuclear Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; and.
5
Radiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
6
Clinical Microbiology Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Department of Medicine, Complutense University, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES), Recinto Hospital Joan March, Bunyola, Spain.

Abstract

It was our purpose to evaluate the clinical impact of systematic PET/CT for the diagnosis of infectious embolisms in patients with infectious endocarditis (IE) in comparison with a historic cohort of IE patients managed without this technique. Detection of extracardiac lesions is an essential component of the management and outcome of IE. Studies using PET/CT for the evaluation of patients with IE are scarce, lack a control group, evaluate a small number of patients, or consist of case reports.

METHODS:

We performed a prospective cohort study (47 patients with definite IE undergoing PET/CT) with matched controls (94 patients with definite IE not undergoing PET/CT) from January 2012 to July 2013 in a tertiary hospital. The results were compared with those of conventional diagnostic techniques and clinical follow-up.

RESULTS:

PET/CT revealed at least 1 lesion in 35 patients (74.5%): 18 showed an embolic complication, 8 showed pathologic uptake on the valves or cardiac devices, 1 showed both, 5 had incidental noninfectious findings, and the findings for 3 were considered false-positive. The validity values for the efficacy of PET/CT in the diagnosis of septic lesions were as follows: sensitivity, 100%; specificity, 80%; positive predictive value, 90%; and negative predictive value, 100%. PET/CT was the only initially positive imaging technique in 15 true-positive cases (55.5%). The systematic use of PET/CT was associated with a 2-fold reduction in the number of relapses (9.6% vs. 4.2%, P = 0.25) and enabled significantly more infectious complications to be diagnosed (18% vs. 57.4%, P = 0.0001).

CONCLUSION:

PET/CT enables the extent of IE to be assessed using a single test. It is fast (<2 h) and comfortable for the patient, gathers whole-body data, and detects significantly more infectious complications.

KEYWORDS:

18F-FDG PET/CT; endocarditis; infectious endocarditis diagnosis; septic embolism

PMID:
24812248
DOI:
10.2967/jnumed.113.134981
[Indexed for MEDLINE]
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