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Clin Infect Dis. 2019 Apr 5. pii: ciz267. doi: 10.1093/cid/ciz267. [Epub ahead of print]

The role of 18F-FDG-PET/CT in the Diagnosis of left-sided Endocarditis: native vs. prosthetic valves endocarditis.

Author information

1
Department of Nuclear Medicine, University of São Paulo Medical School, São Paulo-SP, Brazil.
2
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, Sao Paulo - Brazil.
3
Hospital Israelinta Albert Einstein, Sao Paulo, Brazil.
4
Nuclear Medicine and Molecular Imaging Department, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo-SP, Brazil.
5
Valvular Heart Disease Unit, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo-SP, Brazil.
6
Infection Control Team, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo-SP, Brazil.
7
Emergency Unit, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo-SP, Brazil.
8
Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo-SP, Brazil.
9
Department of Pathology, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo-SP, Brazil.
10
Interdisciplinary Medicine in Cardiology Unit, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo-SP, Brazil.
11
Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
12
Department of Radiology, Hospital of the University of Pennsylvania, PA, USA.
13
Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Co. Antrim, Northern Ireland, UK.

Abstract

BACKGROUND:

18Fluorodeoxyglucose positron emission tomography (18F-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding the use of 18F-FDG-PET/CT for the diagnosis of native valve IE (NVE).

METHODS:

Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. 18F-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE) / ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and 18F-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis.

RESULTS:

Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of 18F-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were: 22%, 100%, 100%, and 66%. The inclusion of abnormal 18F-FDG cardiac uptake as a major criterion at admission enabled a re-categorization of 76% (47/62) of PVE/AAPI cases initially classified as "possible" to "definite" IE. In the histopathological analysis, a predominance of PMN inflammatory infiltrate and reduced extent of fibrosis were observed in the PVE group only.

CONCLUSIONS:

The addition of 18F-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the Modified Duke criteria. In patients presenting with suspected NVE, the use of 18F-FDG-PET/CT is less accurate, and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.

KEYWORDS:

18F-fluorodeoxyglucose; Endocarditis; Heart valve; Positron-Emission Tomography; Prosthetic heart valve

PMID:
30949690
DOI:
10.1093/cid/ciz267

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