[Imaging in infective endocarditis: Not all is ultrasonography]

Area of Science:

• Cardiology
• Radiology
• Infectious Diseases

Background:

• Infective endocarditis (IE) is a severe infection with high mortality, necessitating prompt diagnosis and treatment.
• Current IE diagnosis relies on bacterial, clinical, and echocardiographic criteria.
• Advanced imaging techniques are increasingly vital for IE diagnosis and management.

Purpose of the Study:

• To provide an updated overview of imaging modalities for infective endocarditis.
• To emphasize non-echocardiographic imaging techniques in IE diagnosis.
• To highlight the role of advanced imaging in current clinical guidelines.

Main Methods:

• Review of recent literature on advanced imaging in infective endocarditis.
• Focus on cardiac multislice computed tomography (MSCT) and F18-FDG PET/CT.
• Inclusion of brain MRI for central nervous system embolic events.

Main Results:

• Cardiac MSCT offers detailed anatomical information of valves and perivalve tissue, identifying complications like abscesses and pseudoaneurysms.
• F18-FDG PET/CT enhances IE detection sensitivity and accuracy for systemic embolic events.
• Both MSCT and PET/CT are particularly useful for prosthetic valve endocarditis, outperforming echocardiography in some cases.
• Brain MRI is optimal for evaluating CNS embolic events in IE patients.

Conclusions:

• Advanced imaging, including MSCT and PET/CT, plays a crucial role in modern IE diagnosis.
• These techniques are recommended in recent guidelines and improve diagnostic accuracy, especially in complex cases.
• Integrating advanced imaging improves the comprehensive evaluation and management of infective endocarditis.