Cardiac computed tomography as a viable alternative to echocardiography to detect vegetations and perivalvular complications in patients with infective endocarditis.

Abstract

We considered cardiac computed tomography (CT) as a possible alternative modality to echocardiography in the assessment of infective endocarditis (IE). We evaluated the diagnostic capability of preoperative CT. We retrospectively evaluated the depiction of vegetations and perivalvular complications in preoperative cardiac CT images of 14 patients diagnosed with IE who required surgical intervention, who were seen at our institution from May 30, 2008 to February 3, 2017. We compared the CT findings with those of TTE and TEE assessments, and intraoperative findings. Cardiac CT correctly identified intraoperatively proven vegetations in 12 out of 13 (92.3%) patients and demonstrated 100% sensitivity and positive predictive value in depicting vegetations in the aortic valve and 100% sensitivity, specificity, positive predictive value, and negative predictive value in depicting pseudoaneurysm as perivalvular complications. CT offered superior identification of pseudoaneurysm to that with echocardiography and detected vegetations as small as 6mm in maximal length. Vegetation size correlated well between TEE and CT. Favorable comparison of CT and echocardiography in detecting vegetations and perivalvular complications in patients diagnosed with IE suggested potential for expansion in the use of CT for evaluating organic lesions in patients suspected or diagnosed with IE.