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Lancet Infect Dis. 2017 Jan;17(1):e1-e14. doi: 10.1016/S1473-3099(16)30141-4. Epub 2016 Oct 18.

Diagnostic value of imaging in infective endocarditis: a systematic review.

Author information

1
Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. Electronic address: a.gomes@umcg.nl.
2
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
3
Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
4
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
5
Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
6
Department of Thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
7
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Biomedical Photonic Imaging, University of Twente, Enschede, Netherlands.
8
Department of Internal Medicine, Division of Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
9
Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.

Abstract

Sensitivity and specificity of the modified Duke criteria for native valve endocarditis are both suboptimal, at approximately 80%. Diagnostic accuracy for intracardiac prosthetic material-related infection is even lower. Non-invasive imaging modalities could potentially improve diagnosis of infective endocarditis; however, their diagnostic value is unclear. We did a systematic literature review to critically appraise the evidence for the diagnostic performance of these imaging modalities, according to PRISMA and GRADE criteria. We searched PubMed, Embase, and Cochrane databases. 31 studies were included that presented original data on the performance of electrocardiogram (ECG)-gated multidetector CT angiography (MDCTA), ECG-gated MRI, 18F-fluorodeoxyglucose (18F-FDG) PET/CT, and leucocyte scintigraphy in diagnosis of native valve endocarditis, intracardiac prosthetic material-related infection, and extracardiac foci in adults. We consistently found positive albeit weak evidence for the diagnostic benefit of 18F-FDG PET/CT and MDCTA. We conclude that additional imaging techniques should be considered if infective endocarditis is suspected. We propose an evidence-based diagnostic work-up for infective endocarditis including these non-invasive techniques.

PMID:
27746163
DOI:
10.1016/S1473-3099(16)30141-4
[Indexed for MEDLINE]

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