Diagnostic Performance of 18F-FDG PET/CT in Native Valve Endocarditis: Systematic Review and Bivariate Meta-Analysis

Abstract

Background: Infectious endocarditis is a life-threatening disease, requiring prompt and accurate diagnosis. The aim of this article is to perform a systematic review and meta-analysis of the literature to estimate the performance of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for the diagnosis of native valve endocarditis (NVE). Methods: Selected articles evaluating the diagnostic accuracy of 18F-FDG PET/CT in patients with suspected NVE, resulting from a comprehensive literature search through the PubMed/MEDLINE and Cochrane library databases until April 2020, were included for the systematic review and meta-analysis. Results: Seven studies (351 episodes of suspected NVE) were included. 18F-FDG PET/CT yielded a pooled sensitivity of 36.3% and a pooled specificity of 99.1% for the diagnosis of NVE. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 8.3, 0.6, and 15.3, respectively. The sensitivity increased using contemporary PET/CT device with state-of-the-art patient preparation as well as innovative image acquisitions or adding the results of 18F-FDG PET/CT in a multimodality strategy. Conclusions: In our systematic review and meta-analysis, 18F-FDG PET/CT yielded a poor pooled sensitivity with an otherwise excellent pooled specificity for the diagnosis of NVE; however, several factors may increase the sensitivity without affecting the specificity and these factors should be better evaluated in future studies.

Advantages of 18F-FDG PET/CT Imaging over Modified Duke Criteria and Clinical Presumption in Patients with Challenging Suspicion of Infective Endocarditis

“…In our series, 18 F-FDG PET/CT failed to detect native mitral valve IE in two patients. According to recent data, PET cardiac studies should be performed as ECG-gated and contrast-enhanced PET/CTA to increase the diagnostic accuracy, particularly for the evaluation of native valves [ 16 , 26 , 27 , 28 ]. However, both techniques are not widely available in all nuclear medicine laboratories, and the present study could be considered as an illustration of “real life” 18 F-FDG PET/CT utilization.…”

FDG PET/CT in Cardiac Infection: Does It Matter? A Narrative Review

“…The cohorts are heterogeneous as some included together all types of cardiac infections (NVE, PVE, CIED infection) [5][6][7], while others focused on a specific group of patients, mainly PVE [8][9][10]. Despite the differences in studies' design, prescan protocol, and interpreting criteria used, accumulating data show relatively high sensitivity of FDG PET/CT in PVE (73-93%) compared with a low sensitivity in NVE (22-68%) [5][6][7][11][12][13][14][15]. On the other hand, specificity is high in almost all studies for both NVE (97-100%) [7,11,14] and PVE (80-95%) [7][8][9][10].…”

“…The latter can be achieved by diverting the myocardial metabolism to free fatty acid instead of glucose. Studies investigating FDG PET/CT in cardiac infections had applied different patient preparation protocols [12,15,23]. Recently, standardized recommendations by the European Association of Nuclear Medicine (EANM) and the European Association of Cardiovascular Imaging (EACVI) were established [17].…”

18F-FDG-PET/CT as part of the diagnostic workup of native valve endocarditis: A case report

“…C, D Transaxial view of 18 F-FDG PET/CT (C) and 18 F-FDG PET/CTA (D) showing focal FDG uptake of the chordea tendinae between the valve leaflet and the posteromedial papillary muscle. Due to the poor sensitivity, a negative 18 F-FDG PET/CT cannot rule-out NVE.Based on its excellent specificity, positive valvular-or peri-valvular FDG uptake could be used to rule-in NVE, since no physiological FDG-uptake is expected in this area 1. When using 18 F-FDG PET/CT as major criterion for the NVE diagnosis, with state-of-the art dietary patient preparation, contemporary PET/CT devices (better spatial resolution) as well as delayed cardiac acquisitions (better contrast resolution), the sensitivity of 18 F-FDG PET/CT in the NVE diagnosis is increased up to 80%, without altering the excellent specificity 2.…”