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Infective endocarditis: Beyond the usual tests

Nkemdilim Mgbojikwe1,2, Steven R Jones3,4, Thorsten M Leucker5,6

  • 1Assistant Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Cleveland Clinic Journal of Medicine
|August 7, 2019
PubMed

Insights

Diagnosing infective endocarditis is difficult, as echocardiography misses many cases. Advanced imaging like 4D CT and FDG-PET improve diagnosis sensitivity, particularly for prosthetic valve endocarditis.

Area of Science:

  • Cardiology
  • Radiology
  • Nuclear Medicine

Background:

  • Infective endocarditis (IE) diagnosis presents significant challenges.
  • Echocardiography, the standard imaging modality, has limitations and can miss up to 30% of IE cases.

Purpose of the Study:

  • To evaluate the role of newer imaging modalities in improving the diagnostic sensitivity of infective endocarditis.
  • To assess the utility of 4D CT, FDG-PET, and leukocyte scintigraphy as adjuncts to echocardiography.

Main Methods:

  • Review of newer imaging techniques including 4-dimensional computed tomography (4D CT), fluorodeoxy-glucose positron emission tomography (FDG-PET), and leukocyte scintigraphy.
  • Comparison of the diagnostic performance of these advanced imaging tests against echocardiography in select patient populations.

Main Results:

  • Newer imaging tests demonstrate potential to enhance the sensitivity of IE diagnosis.
  • These advanced modalities are particularly beneficial in complex cases, such as those involving prosthetic valves.

Conclusions:

  • Advanced imaging techniques like 4D CT and FDG-PET offer valuable improvements in diagnosing infective endocarditis.
  • Appropriate utilization of these tests, especially in prosthetic valve endocarditis, can overcome limitations of traditional echocardiography.

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