18-Fluoro-2-deoxyglucose positron emission tomography-computed tomography – An additional tool in the diagnosis of prosthetic valve endocarditis.
Int J Infect Dis. 2014 Nov;28:219-24.
Ricciardi A1, Sordillo P1, Ceccarelli L1, Maffongelli G1, Calisti G2, Di Pietro B3, Caracciolo CR3, Schillaci O3, Pellegrino A4, Chiariello L4, Andreoni M1, Sarmati L5.
1Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy.
2Department of Virology, Royal Free London NHS Foundation Trust, London, UK.
3Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Rome, Italy.
4Cardiac Surgery Unit, Tor Vergata University, Rome, Italy.
5Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Rome, Italy. Electronic address: firstname.lastname@example.org
To evaluate the role of 18-fluoro-2-deoxyglucose positron emission tomography-computed tomography ((18)F-FDG-PET-CT) in the diagnosis of infectious endocarditis (IE).
We retrospectively examined 27 consecutive patients who were admitted to the Infectious Diseases Department of Tor Vergata University Hospital between 2009 and 2013 with a suspicion of IE. The final IE diagnosis was defined according to the modified Duke criteria, and the microbiological and diagnostic results were collected for each patient.
Twenty out of 27 patients had a suspected prosthetic valve endocarditis (PVE) and seven had a suspected native valve endocarditis (NVE). Twenty-five out of 27 patients (92%) had a confirmed diagnosis of IE (18/25 PVE and 7/25 NVE); 16 had a positive echocardiography evaluation and 16 had positive (18)F-FDG-PET-CT findings. Echocardiography showed a higher sensitivity as a diagnostic tool for the detection of IE compared to (18)F-FDG-PET-CT (80% vs. 55%). However, a greater number of PVE had positive (18)F-FDG-PET-CT results compared to those with positive echocardiography findings (11/13 vs. 9/13), and overall 89% (16/18) of confirmed PVE resulted (18)F-FDG-PET-CT positive. Analyzing only the cases who underwent transoesophageal echocardiography, (18)F-FDG-PET-CT showed a sensitivity of 85% in PVE (vs. 69% for echocardiography and 77% for the Duke criteria). All seven patients with NVE had a positive echocardiography and negative (18)F-FDG-PET-CT findings (p<0.001).
The results of this study further highlight the limitations of echocardiography in the diagnosis of PVE and the potential advantages of (18)F-FDG-PET-CT in these cases.