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Diagnostic value of imaging in infective endocarditis: a systematic review
Anna Gomes1, Andor W J M Glaudemans2, Daan J Touw3
1Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Abstract:
Sensitivity and specificity of the modified Duke criteria for native valve endocarditis are both suboptimal, at approximately 80%. Diagnostic accuracy for intracardiac prosthetic material-related infection is even lower. Non-invasive imaging modalities could potentially improve diagnosis of infective endocarditis; however, their diagnostic value is unclear. We did a systematic literature review to critically appraise the evidence for the diagnostic performance of these imaging modalities, according to PRISMA and GRADE criteria. We searched PubMed, Embase, and Cochrane databases. 31 studies were included that presented original data on the performance of electrocardiogram (ECG)-gated multidetector CT angiography (MDCTA), ECG-gated MRI, 18F-fluorodeoxyglucose (18F-FDG) PET/CT, and leucocyte scintigraphy in diagnosis of native valve endocarditis, intracardiac prosthetic material-related infection, and extracardiac foci in adults. We consistently found positive albeit weak evidence for the diagnostic benefit of 18F-FDG PET/CT and MDCTA. We conclude that additional imaging techniques should be considered if infective endocarditis is suspected. We propose an evidence-based diagnostic work-up for infective endocarditis including these non-invasive techniques.
Insights
The modified Duke criteria for infective endocarditis have suboptimal accuracy. Advanced imaging like 18F-FDG PET/CT and MDCTA show weak but promising diagnostic benefits, suggesting their inclusion in diagnostic work-ups.
Area of Science:
- Cardiology
- Infectious Diseases
- Radiology
Background:
- The modified Duke criteria for native valve endocarditis (NVE) exhibit suboptimal sensitivity and specificity (~80%).
- Diagnostic accuracy for prosthetic material-related infections is even lower.
- Non-invasive imaging modalities may enhance infective endocarditis (IE) diagnosis, but their value is uncertain.
Purpose of the Study:
- To systematically review and appraise the diagnostic performance of non-invasive imaging techniques for IE.
- To evaluate electrocardiogram (ECG)-gated multidetector CT angiography (MDCTA), ECG-gated MRI, 18F-fluorodeoxyglucose (18F-FDG) PET/CT, and leucocyte scintigraphy.
- To assess diagnostic accuracy for NVE, prosthetic valve endocarditis, and extracardiac foci in adults.
Main Methods:
- Systematic literature review adhering to PRISMA and GRADE criteria.
- Searched PubMed, Embase, and Cochrane databases for relevant studies.
- Included 31 studies presenting original data on imaging modality performance.
Main Results:
- Weak but consistent evidence suggests a diagnostic benefit for 18F-FDG PET/CT and MDCTA in IE diagnosis.
- Suboptimal performance of existing criteria necessitates improved diagnostic tools.
- Non-invasive imaging shows potential for improving IE detection rates.
Conclusions:
- Additional non-invasive imaging techniques should be considered when IE is suspected.
- 18F-FDG PET/CT and MDCTA demonstrate promising diagnostic utility.
- An evidence-based diagnostic work-up incorporating these advanced imaging modalities is proposed.
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