Cardiac Imaging of Infective Endocarditis, Echo and Beyond.

Abstract

The visualization of cardiac lesions is a major component of the diagnosis of infective endocarditis (IE). We review the usefulness of different cardiac imaging techniques for the diagnosis and management of IE. Transthoracic echocardiography is indicated in all cases of suspected IE. Transesophageal echocardiography is used in most patients due to its higher sensitivity. When diagnosis remains doubtful, in particular for IE on foreign material, multislice computed tomography and nuclear medicine techniques, i.e., positron emission tomography and radiolabelled leucocyte scintigraphy, enable a higher proportion of IE to be classified as definite or rejected at an early stage. Imaging also plays a role in prognostic stratification and follow-up. Nuclear medicine and radiological imaging techniques are useful to diagnose cardiac lesions on IE when echocardiography is not conclusive. They should be used in selected patients and their findings should be integrated in a multidisciplinary management in endocarditis teams.