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Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques

Anna Gomes1, Peter Paul van Geel2, Michiel Santing3

  • 1Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1 (HPC:EB80), 9713GZ, Groningen, The Netherlands. a.gomes@umcg.nl.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|August 2, 2018
PubMed

Insights

This study validates a flowchart for diagnosing infective endocarditis using multimodality imaging. Echocardiography, MDCTA, and FDG-PET/CT offer complementary information, especially for patients with prosthetic material.

Area of Science:

  • Cardiology
  • Radiology
  • Infectious Diseases

Background:

  • Infective endocarditis diagnosis often requires multimodality imaging.
  • The utility of additional imaging modalities beyond echocardiography, guided by a specific flowchart, remains unevaluated.

Purpose of the Study:

  • To assess the applicability of a diagnostic imaging flowchart for infective endocarditis.
  • To compare the diagnostic performance of echocardiography, MDCTA, and FDG-PET/CT in patients with suspected endocarditis.

Main Methods:

  • An observational, single-center study enrolled 176 adult patients with suspected endocarditis or device infection.
  • Adherence to a proposed diagnostic imaging flowchart was evaluated.
  • Imaging techniques (echocardiography, MDCTA, FDG-PET/CT) were directly compared in 46 patients.

Main Results:

  • 69% of patients adhered to the flowchart.
  • In patients without prosthesis, echocardiography showed the highest sensitivity (71%), while MDCTA and FDG-PET/CT had specific roles.
  • In patients with prosthesis, all modalities combined achieved 100% sensitivity, with FDG-PET/CT excelling in cardiac device infections.

Conclusions:

  • The evaluated imaging flowchart is practical for routine clinical use.
  • Echocardiography, MDCTA, and FDG-PET/CT provide valuable, complementary diagnostic data.
  • These advanced imaging techniques are particularly beneficial for patients with intracardiac prosthetic material.
Abstract

Keywords:
CTEchoPETdiagnostic and prognostic applicationinfectionvalvular heart disease

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