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

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 5 0.25) and enabled significantly more infectious complications to be diagnosed (18% vs. 57.4%, P 5 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.

Characterization of 18 F-Fluorodeoxyglucose Uptake Pattern in Noninfected Prosthetic Heart Valves

“…There is increasing evidence that FDG positron emission tomography (PET)/computed tomography (CT) may be useful in the management of infective endocarditis, both for detection of septic emboli [9][10][11][12][13] and for diagnosis of prosthetic valve infection. [14][15][16] A study showed that the sensitivity of the modified Duke criteria performed at admission was markedly increased when the presence of an abnormal FDG uptake was added as a major criterion.…”

FDG PET/CT for the diagnosis and management of infective endocarditis: Expert consensus vs evidence-based practice

“…In a prospective study of patients with a diagnosed native valve infective endocarditis, FDG PET/CT identified additional infection sites in 74.5% of the patients, such as the lungs, skeleton, brain, and other organs. Based on the information of extra-cardiac findings on FDG PET/ CT, the incidence of relapse infective endocarditis was decreased by 2-folds because of appropriate intervention as a result of the extra-cardiac findings on FDG PET/ CT. 18 …”

Endocarditis and Calcific Uremic Arteriolopathy: Is it a Coincidence or an Association? Case Report

“…If these acral findings exist, the diagnosis may be confused with infective endocarditis especially when valvular involvement is detected on echocardiography. Both FDG and NaF (sodium fluoride) PET/CT imaging can be used to obtain advanced information about the valvular lesions (11,12). In our case, we used NaF PET/CT because of severe calcification on CT.…”

“…In our case, we used NaF PET/CT because of severe calcification on CT. It is a powerful technique to differentiate whether the lesion is due to sole calcification or secondary to other inflammation causes (12). It showed NaF (sodium fluoride) uptakes on the valves with calcified masses.…”