The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis

Abstract

The exact incidence of extra-cardiac complications (ECC) in patients with infective endocarditis (IE) is unknown but presumed to be high. These patients, although mostly asymptomatic, may require a more aggressive therapeutic approach. (18)fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used for the diagnosis of infections, but its role in the early diagnosis of IE complications is still unclear. This study aimed to evaluate the role of FDG-PET/CT in the early diagnosis of ECC in IE and its implications for medical management. We prospectively studied 40 consecutive patients with a confirmed diagnosis of IE (according to the modified Duke criteria) who underwent a whole body FDG-PET/CT study within 14 days from diagnosis. The FDG-PET/CT demonstrated ECC in 17 (42.5%) patients, while 8 (38.1%) of them were asymptomatic. The most frequent embolic sites were musculoskeletal and splenic. Owing to the FDG-PET/CT findings, treatment planning was modified in 14 (35%) patients. This included antibiotic treatment prolongation (27.5%), referral to surgical procedures (15%) and, most substantially, prevention of unnecessary device extraction (17.7%). According to our experiences, FDG-PET/CT imaging was useful in the detection of embolic and metastatic infections in IE. This clinical information had a significant diagnostic and therapeutic impact in managing IE disease.

Diagnostic Accuracy of 18F-FDG PET/CT in Infective Endocarditis and Implantable Cardiac Electronic Device Infection: A Cross-Sectional Study

“…We included patients with a clear suggestion of native or PV IE and ICED IE or infection, at least accomplishing Duke modified criteria to be initially considered as possible cases. After the diagnostic process, including 18 F-FDG PET/CT and other tests, cases were classified according to modified Duke criteria (4) as rejected, definite, or possible. In the case of ICED, and due to the common management in all cases (removal of the device), we used the definitions provided by the last British Society for Antimicrobial Chemotherapy guidelines (20) for those cases not presenting vegetations (i.e., pocket infection and ICED lead infection).…”

“…Therefore, prospects in the approach of IE rely on available and easy-to-perform tests that provide data on different issues promptly, so that early measures could be applied. 18 F-FDG PET/CT is an emerging image technique that has proven useful in the diagnosis of a variety of infectious diseases (10,11). Its utility is due to the ability of 18 F-FDG to actively incorporate into activated leukocytes, macrophages, and CD4-positive T cells present at the sites of infection (12,13).…”

“…18 F-FDG PET/CT is an emerging image technique that has proven useful in the diagnosis of a variety of infectious diseases (10,11). Its utility is due to the ability of 18 F-FDG to actively incorporate into activated leukocytes, macrophages, and CD4-positive T cells present at the sites of infection (12,13). Recent studies have reported encouraging results for 18 F-FDG PET/CT in the diagnosis of IE and ICED infection (14)(15)(16) as well as in the detection of extracardiac complications (17,18).…”

“…Its utility is due to the ability of 18 F-FDG to actively incorporate into activated leukocytes, macrophages, and CD4-positive T cells present at the sites of infection (12,13). Recent studies have reported encouraging results for 18 F-FDG PET/CT in the diagnosis of IE and ICED infection (14)(15)(16) as well as in the detection of extracardiac complications (17,18). In the most recent guidelines (2015) of the European Society of Cardiology, 18 F-FDG PET/CT has been included as a major criterion of PV endocarditis (PVE) diagnosis and also in the diagnostic algorithm for the detection of embolic events for both native valve IE (NVE) and PVE (7).…”

18F-FDG PET/CT in the Diagnostic Workup of Infective Endocarditis and Related Intracardiac Prosthetic Material: A Clear Message

“…In addition to the diagnostic consequences, 18 F-FDG PET/CT has been previously shown to have important therapeutic consequences in a significant number (35%) of cases, for both IE and its extracardiac complications (6). Therapeutic consequences included adjustments of antibiotic regimens, eradication of the port of entry and metastatic foci, indication for surgery (a high negative predictive value helps to select eligible patients to dismiss surgery), prevention of unnecessary device extraction, and length of follow-up.…”