Advantages and limitations of 18-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in the diagnosis of infective endocarditis

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

“…A third study reported a 74% rate of positive blood culture [ 19 ]. Two studies reported the presence of fever in about 70% of their study population [ 17 , 19 ], with a C-reactive protein (CRP) mean value of 78.5 mg/L in one of these studies [ 17 ], similar to the CRP mean value of another study [ 18 ]. Most patients were treated with antibiotics prior to 18 F-FDG PET/CT, with a mean duration of treatment ranging from 7 to 30 days [ 17 , 19 , 20 , 21 ].…”

“…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.…”

“…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 all studies, the physiological myocardial 18 F-FDG uptake suppression was obtained through high-fat low-carbohydrate (HFLC) diet for 12 to 24 h and at least 6 to 8 h prolonged fasting prior administration of 18 F-FDG. Moreover, a bolus of unfractionated heparin (50 IU/kg) was injected, when not contraindicated [ 17 , 18 , 21 ]. No indication about heparin administration was given in four studies [ 19 , 20 , 22 , 23 ].…”

“…No indication about heparin administration was given in four studies [ 19 , 20 , 22 , 23 ]. The images were acquired 60 min after administration of 18 F-FDG in the vast majority of studies, except for one, where the images were performed earlier at 45 min [ 18 ]. Four studies used a Biograph mCT hybrid PET/CT (Siemens) [ 17 , 20 , 21 , 22 ] with different technical performance, and one used a Gemini-TF hybrid PET/CT (Philips) [ 19 ].…”