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18F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization.

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Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) aids in diagnosing infective endocarditis by detecting intracardiac infections and disseminated disease. Its effectiveness varies by cardiac condition, with higher accuracy for prosthetic valves and device pocket infections.

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Area of Science:

  • Nuclear Medicine
  • Cardiology
  • Infectious Diseases

Background:

  • International guidelines now include advanced imaging like FDG-PET/CT for suspected infective endocarditis.
  • Accurate diagnosis of infective endocarditis is crucial for timely and effective patient management.

Purpose of the Study:

  • To review the indications for using FDG-PET/CT in suspected infective endocarditis.
  • To outline standardized approaches for FDG-PET/CT in this clinical setting.

Main Methods:

  • Review of current literature and guidelines regarding FDG-PET/CT in infective endocarditis.
  • Analysis of diagnostic performance based on valve type (native, prosthetic) and cardiac devices.
  • Consideration of combined imaging modalities like CTA with FDG-PET/CT for specific cases.

Main Results:

  • FDG-PET/CT detects both intracardiac infections and disseminated disease, aiding diagnosis.
  • Sensitivity varies: poor for native valve endocarditis and lead infections, high for prosthetic valve endocarditis and device pocket infections.
  • Specificity is generally high across indications; disseminated disease detection impacts management.

Conclusions:

  • FDG-PET/CT is valuable for suspected infective endocarditis, especially for prosthetic valves and disseminated disease.
  • Standardization of patient preparation, acquisition, and interpretation is essential for optimal performance.
  • While not ruling out native valve endocarditis, positive FDG-PET/CT findings strongly support the diagnosis.