18F-fluorodeoxyglucose positron-emission tomography combined with computed tomography as a diagnostic tool in native valve endocarditis

Abstract

A negative F-FDG-PET/CT result should not be interpreted as an exclusion of NVE. In patients with possible or rejected NVE according to the modified-Duke criteria, F-FDG-PET/CT could be used in case of sustained suspicion of NVE owing to its high specificity in case of abnormal FDG uptake at the valve region. F-FDG-PET/CT is important for detecting metastatic infection which already warrants the need to perform F-FDG-PET/CT in all patients with suspected NVE.

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

“…After full-text screening, six articles were excluded from the systematic review as well as from the meta-analysis, because of missing information to assess both sensitivity and specificity of 18 F-FDG PET/CT. Therefore, seven articles with a total of 351 episodes of suspected NVE were included in the qualitative (systematic review) as well as in the quantitative analysis (meta-analysis) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Figure 1 summarizes the literature search results.…”

“…Of note, the selected studies were mostly performed in Europe, except for two which were performed in North America [ 17 ] and South America [ 19 ]. There were all monocentric and mostly prospective, except for two retrospective studies [ 17 , 22 ]. The articles were published between 2016 and 2020.…”

“…Five studies included a total of 722 episodes with clinical suspicion of IE, with a subgroup of 209 episodes with suspected NVE [ 18 , 19 , 20 , 21 , 23 ]. Two studies were exclusively dedicated to assess the accuracy of 18 F-FDG PET/CT in 142 patients with clinical suspected NVE [ 17 , 22 ]. In six studies, the mean age of the patients ranged from 58 to 71 years with a proportion of 68.1% of males, whereas corresponding data could not be assessed in one study [ 23 ].…”

“…In six studies, the mean age of the patients ranged from 58 to 71 years with a proportion of 68.1% of males, whereas corresponding data could not be assessed in one study [ 23 ]. Two studies reported the percentage of positive echocardiographic findings, ranging from 19% to 42% [ 20 , 22 ]. These two studies reported a rate of positive blood culture of 52% and 100% of the study population, partly because only blood culture positive patients were included in the second study by Kouijzer et al [ 22 ].…”

Endokarditis

“…In der Diagnostik der Schrittmacher/ICD-Endokarditis ist anzumerken, dass das FDG-PET/CT in der DetektionvonVegetationenoderentzündlichenLäsionen im Bereich der Elektroden oder benachbarten muralen Strukturen deutlich schlechter abschneidet als bei der Visualisierung von Schrittmacher-/ICD-Tascheninfektionen. Auch bei der Nativklappen-Endokarditis sind die kardialenLäsionen(imUnterschiedzuextrakardialen)oft nicht gut detektierbar [13]. In der klinischen Praxis ist zur DiagnoseeinerTascheninfektionseltenjedochkomplementäre Bildgebung erforderlich.…”