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. 2021 Mar;114(3):211-220.
doi: 10.1016/j.acvd.2020.10.005. Epub 2021 Jan 22.

18F-fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of native valve infective endocarditis: A prospective study

Mary Philip  1 , Sarkis Delcourt  2 , Julien Mancini  3 , Laetitia Tessonnier  2 , Serge Cammilleri  2 , Florent Arregle  1 , Hélène Martel  1 , Leopold Oliver  1 , Sandrine Hubert  1 , Sébastien Renard  1 , Laurence Camoin  4 , Anne Claire Casalta  1 , Jean Paul Casalta  4 , Frédérique Gouriet  4 , Alberto Riberi  5 , Hubert Lepidi  4 , Frederic Collart  5 , Didier Raoult  4 , Michel Drancourt  4 , Gilbert Habib  6
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Free article

18F-fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of native valve infective endocarditis: A prospective study

Mary Philip et al. Arch Cardiovasc Dis. 2021 Mar.
Free article

Abstract

Background: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) has recently been added as a major criterion in the European Society of Cardiology (ESC) 2015 infective endocarditis guidelines. PET/CT is currently used in patients with suspected prosthetic valve and cardiac device-related endocarditis. However, the value of the ESC classification and the clinical impact of PET findings are unknown in patients with native valve endocarditis (NVE).

Aims: Our aims were: to assess the value of the ESC criteria (including PET/CT) in NVE; to determine the usefulness of PET/CT concerning embolic detection; and to describe a new PET/CT feature (diffuse splenic uptake).

Methods: Between 2012 and 2017, 75 patients with suspected NVE were included prospectively, after exclusion of patients with uninterpretable or unfeasible PET/CT. Using gold standard expert consensus, 63 cases of infective endocarditis were confirmed and 12 were rejected.

Results: Significant valvular uptake was observed in 11 of 63 patients with definite NVE and in no patients who had the diagnosis of infective endocarditis rejected (sensitivity 17.5%, specificity 100%). Among the 63 patients with NVE, a peripheral embolism or mycotic aneurysm was observed in 20 (31.7%) cases. Application of the ESC criteria increased Duke criteria sensitivity from 63.5% to 69.8% (P<0.001), without a change in specificity. Diffuse splenic uptake was observed in 39 (52.0%) patients, including 37 (58.7%) with a final diagnosis of NVE (specificity 83.3%).

Conclusions: 18F-FDG PET/CT has poor sensitivity but high specificity in the diagnosis of NVE. The usefulness of 18F-FDG PET/CT is high for embolic detection. Diffuse splenic uptake represents a possible new diagnostic criterion for NVE.

Keywords: Endocardite; Endocarditis; Guidelines; Imagerie nucléaire; Nuclear imaging; Recommandations; Valve disease; Valvulopathie.

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