Introduction

18F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET/CT) is not routinely recommended for the diagnosis of infective endocarditis (IE) due to the lack of clinical impact.

Materials and methods

Between January 2016 and January 2020, clinical data from patients with a possible diagnosis of IE were reviewed retrospectively to evaluate the value of ¹⁸F-FDG-PET/CT in the diagnosis of IE. ¹⁸F-FDG PET/CT scan was performed as an additional diagnostic tool in possible IE when echocardiography was inconclusive or in patients with definite IE to identify extracardiac complications. Cases were classified according to modified Duke criteria as rejected, definite or possible.

Results

313 patients with suspected IE were included. 72 (23%) patients underwent 18F-FDG PET/CT. ¹⁸F-FDG PET/CT resulted in a reclassification of Duke criteria in 29/72 (40%) patients, from “possible” to “definite” (n, 10) and to “rejected” (n, 19). Patients who benefited from a Duke criteria reclassification following ¹⁸F-FDG PET/CT were more frequently classified as possible IE at inclusion or had a non-conclusive baseline echocardiography (100% vs 58%; p 0.001) and had more likely a prosthetic metallic valve replacement (59% vs 21%; p 0.001). Abnormal perivalvular uptake was identified in 46 patients (71% prosthetic vs 50% native; p 0.118). ¹⁸F-FDG PET/CT identified extracardiac uptake consistent with septic emboli in 14/72 (19%) patients. In addition, extracardiac uptake indicative of an alternative diagnosis was identified in 5 patients (2% prosthetic vs 17% native; p 0.039).

Conclusion

The use of ¹⁸F-FDG-PET/CT has shown to be useful in the diagnosis of IE, particularly in prosthetic IE and may provide additional value in the detection of septic emboli and/or the identification of an alternative diagnosis different from IE.

Graphical abstract

中文翻译：

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18F-FDG PET/CT对感染性心内膜炎的诊断价值

介绍

由于缺乏临床影响，不常规推荐18F-氟脱氧葡萄糖正电子发射断层扫描 ( ¹⁸ F-FDG-PET/CT) 用于诊断感染性心内膜炎 (IE)。

材料和方法

2016年1月至2020年1月，回顾性分析可能诊断为IE的患者的临床资料，评价¹⁸ F-FDG-PET/CT在IE诊断中的价值。¹⁸ F-FDG PET/CT 扫描作为额外的诊断工具在超声心动图不确定或有明确 IE 的患者中用于识别心外并发症时可能的 IE。根据修改后的杜克标准将病例分类为拒绝、确定或可能。

结果

313 名疑似 IE 患者被纳入研究。72 名 (23%) 患者接受了 18F-FDG PET/CT。¹⁸ F-FDG PET/CT 导致 29/72 (40%) 患者的杜克标准重新分类，从“可能”到“确定”( n , 10) 和“拒绝”( n , 19)。^在18 F-FDG PET/CT后受益于杜克标准重新分类的患者在纳入时更常被归类为可能的 IE，或有非结论性基线超声心动图（100% 对 58%；p = 0.001）并且更可能有假体金属瓣膜置换术（59% 对 21%；p = 0.001）。在 46 名患者中发现了瓣周摄取异常（71% 假体对 50% 天然；p = 0.118）。¹⁸F-FDG PET/CT 在 14/72 (19%) 的患者中发现心外摄取与脓毒性栓子一致。此外，在 5 名患者中发现了指示替代诊断的心外摄取（2% 假体对 17% 天然；p = 0.039）。

结论

使用¹⁸ F-FDG-PET/CT 已被证明可用于 IE 的诊断，特别是在假体 IE 中，并且可能在检测脓毒性栓子和/或识别不同于 IE 的替代诊断方面提供额外的价值。

图形概要