Purpose of Review

Additional imaging modalities, such as FDG-PET/CT, have been included into the workup for patients with suspected infective endocarditis, according to major international guidelines published in 2015. The purpose of this review is to give an overview of FDG-PET/CT indications and standardized approaches in the setting of suspected infective endocarditis.

Recent Findings

There are two main indications for performing FDG-PET/CT in patients with suspected infective endocarditis: (i) detecting intracardiac infections and (ii) detection of (clinically silent) disseminated infectious disease. The diagnostic performance of FDG-PET/CT for intracardiac lesions depends on the presence of native valves, prosthetic valves, or implanted cardiac devices, with a sensitivity that is poor for native valve endocarditis and cardiac device-related lead infections, but much better for prosthetic valve endocarditis and cardiac device-related pocket infections. Specificity is high for all these indications. The detection of disseminated disease may also help establish the diagnosis and/or impact patient management.

Summary

Based on current evidence, FDG-PET/CT should be considered for detection of disseminated disease in suspected endocarditis. Absence of intracardiac lesions on FDG-PET/CT cannot rule out native valve endocarditis, but positive findings strongly support the diagnosis. For prosthetic valve endocarditis, standard use of FDG-PET/CT is recommended because of its high sensitivity and specificity. For implanted cardiac devices, FDG-PET/CT is also recommended, but should be evaluated with careful attention to clinical context, because its sensitivity is high for pocket infections, but low for lead infections. In patients with prosthetic valves with or without additional aortic prosthesis, combination with CTA should be considered. Optimal timing of FDG-PET/CT is important, both during clinical workup and technically (i.e., post tracer injection). In addition, procedural standardization is key and encompasses patient preparation, scan acquisition, reconstruction, subsequent analysis, and clinical interpretation. The recommendations discussed here will hopefully contribute to improved standardization and enhanced performance of FDG-PET/CT in the clinical management of patients with suspected infective endocarditis.

中文翻译：

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感染性心内膜炎的 18F-FDG PET/CT：适应症和标准化方法

审查目的

根据 2015 年发布的主要国际指南，其他成像方式，例如 FDG-PET/CT，已被纳入疑似感染性心内膜炎患者的检查中。本综述的目的是概述 FDG-PET/CT疑似感染性心内膜炎的适应症和标准化方法。

最近的发现

对疑似感染性心内膜炎患者进行 FDG-PET/CT 有两个主要适应症：(i) 检测心内感染和 (ii) 检测（临床无症状的）播散性传染病。FDG-PET/CT 对心内病变的诊断性能取决于是否存在自体瓣膜、人工瓣膜或植入的心脏装置，其对自体瓣膜心内膜炎和心脏装置相关的铅感染的敏感性较差，但对人工瓣膜心内膜炎和心脏装置相关的囊袋感染。所有这些适应症的特异性都很高。播散性疾病的检测也可能有助于确定诊断和/或影响患者管理。

概括

根据目前的证据，应考虑使用 FDG-PET/CT 检测疑似心内膜炎的播散性疾病。FDG-PET/CT 无心内病灶不能排除自发瓣膜心内膜炎，但阳性结果有力支持诊断。对于人工瓣膜心内膜炎，推荐标准使用 FDG-PET/CT，因为它具有高敏感性和特异性。对于植入的心脏装置，也推荐使用 FDG-PET/CT，但应仔细评估临床情况，因为其对囊袋感染的敏感性较高，但对铅感染的敏感性较低。对于有或没有附加主动脉瓣的人工瓣膜患者，应考虑与 CTA 联合使用。FDG-PET/CT 的最佳时机很重要，无论是在临床检查期间还是在技术上（即示踪剂注射后）。此外，程序标准化是关键，包括患者准备、扫描采集、重建、后续分析和临床解释。此处讨论的建议有望有助于提高 FDG-PET/CT 在疑似感染性心内膜炎患者临床管理中的标准化和性能。