![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
18F-FDG PET/CT improves diagnostic certainty in native and prosthetic valve Infective Endocarditis over the modified
Christopher P Primus1,2, Thomas A Clay3, Maria S McCue4
1Barts Heart Centre, St Bartholomew's Hospital, London, UK. christopher.primus@nhs.net.
Background:
International guidance recognizes the shortcomings of the modified Duke Criteria (mDC) in diagnosing infective endocarditis (IE) when transoesophageal echocardiography (TOE) is equivocal. 18F-FDG PET/CT (PET) has proven benefit in prosthetic valve endocarditis (PVE), but is restricted to extracardiac manifestations in native disease (NVE). We investigated the incremental benefit of PET over the mDC in NVE.
Methods:
Dual-center retrospective study (2010-2018) of patients undergoing myocardial suppression PET for NVE and PVE. Cases were classified by mDC pre- and post-PET, and evaluated against discharge diagnosis. Receiver Operating Characteristic (ROC) analysis and net reclassification index (NRI) assessed diagnostic performance. Valve standardized uptake value (SUV) was recorded.
Results:
69/88 PET studies were evaluated across 668 patients. At discharge, 20/32 had confirmed NVE, 22/37 PVE, and 19/69 patients required surgery. PET accurately re-classified patients from possible, to definite or rejected (NRI: NVE 0.89; PVE 0.90), with significant incremental benefit in both NVE (AUC 0.883 vs 0.750) and PVE (0.877 vs 0.633). Sensitivity and specificity were 75% and 92% in NVE; 87% and 86% in PVE. Duration of antibiotics and C-reactive Protein level did not impact performance. No diagnostic SUV cut-off was identified.
Conclusion:
PET improves diagnostic certainty when combined with mDC in NVE and PVE.
Insights
¹⁸F-FDG PET/CT enhances the diagnosis of infective endocarditis (IE), particularly in native valve endocarditis (NVE) cases where traditional methods are uncertain. This imaging technique significantly improves diagnostic accuracy when used alongside the modified Duke Criteria (mDC).
Area of Science:
- Nuclear Medicine
- Cardiology
- Infectious Diseases
Background:
- The modified Duke Criteria (mDC) have limitations in diagnosing infective endocarditis (IE), especially with equivocal transesophageal echocardiography (TOE) results.
- While ¹⁸F-FDG PET/CT (PET) is beneficial for prosthetic valve endocarditis (PVE), its utility in native valve endocarditis (NVE) has been primarily for extracardiac manifestations.
Purpose of the Study:
- To investigate the additional diagnostic value of PET imaging compared to the mDC for NVE.
- To assess PET's performance in both NVE and PVE when used in conjunction with the mDC.
Main Methods:
- A retrospective dual-center study included patients undergoing myocardial suppression PET for NVE and PVE between 2010 and 2018.
- Patients were classified using mDC before and after PET, with final diagnosis based on discharge records.
- Diagnostic performance was evaluated using Receiver Operating Characteristic (ROC) analysis and net reclassification index (NRI), with valve standardized uptake value (SUV) recorded.
Main Results:
- PET accurately reclassified patients, improving diagnostic certainty from 'possible' to 'definite' or 'rejected' IE (NRI: NVE 0.89, PVE 0.90).
- PET demonstrated significant incremental diagnostic benefit over mDC alone in both NVE (AUC 0.883 vs 0.750) and PVE (AUC 0.877 vs 0.633).
- Sensitivity and specificity were 75% and 92% for NVE, and 87% and 86% for PVE, respectively; no diagnostic SUV cut-off was identified.
Conclusions:
- ¹⁸F-FDG PET/CT significantly enhances diagnostic certainty for infective endocarditis.
- Combining PET with the modified Duke Criteria offers incremental diagnostic value for both native and prosthetic valve endocarditis.
More Related Videos
Related Concept Videos
01:29Endocarditis IV: Nursing Management
01:28Imaging Studies for Cardiovascular System V: CT
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:18Endocarditis III: Medical Management
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...