Abstract
BackgroundWe assessed the diagnostic value of FDG PET/CT in a real-world cohort of patients with surgically managed infective endocarditis (IE). MethodsWe performed a retrospective analysis of all patients hospitalized in a tertiary IE referral medical center from January 2014 to October 2018 fulfilling the following criteria: ICD-10 code for IE and OPS code for both, heart surgery and FDG PET/CT. ResultsFinal analysis included 29 patients, whereof 28 patients had surgically proven IE. FDG PET/CT scan was true-positive in 15 patients (sensitivity (SEN) 56%) and false-negative in 12 patients. Combination of Duke criteria (DC) with FDG PET/CT scan resulted in gain of SEN for all patients with confirmed IE (SEN of DC 79% vs SEN of combination DC and FDG PET/CT 89%), driven by a relevant gain in PVE patients only (SEN of DC 78% vs SEN of combination DC and FDG PET/CT 94%). Interestingly, higher prosthesis age was observed in patients with false-negative scans. ConclusionsWe found a SEN of 56% for FDG PET/CT in a real-world cohort of patients with surgically proven IE which was associated with a 16% gain of IE diagnosis in patients with PVE when combined with DC.
Highlights
Despite medical advancements management of infective endocarditis (IE) is still challenging both from a diagnostic as well as from a therapeutic point of view
We found a SEN of 56% for FDG PET/CT in a real-world cohort of patients with surgically proven IE which was associated with a 16% gain of IE diagnosis in patients with prosthesis valve endocarditis (PVE) when combined with Duke criteria (DC). (J Nucl Cardiol 2020)
ESC guidelines are based on studies in which IE diagnosis in PVE and cardiac device-related infective endocarditis (CDRIE) patients was predominantly made by expert teams, respectively, by Duke classification
Summary
Despite medical advancements management of infective endocarditis (IE) is still challenging both from a diagnostic as well as from a therapeutic point of view. ESC guidelines are based on studies in which IE diagnosis in PVE and cardiac device-related infective endocarditis (CDRIE) patients was predominantly made by expert teams, respectively, by Duke classification.. More recent studies investigating the diagnostic value of FDG PET/CT in suspected IE have mainly used expert opinion or DC as reference standard for definite IE diagnosis.. An assessment of the diagnostic value of FDG PET/ CT via surgical confirmation as reference standard for definite IE is largely missing. This lack of definite surgical diagnosis may complicate interpretation of FDG PET/CT sensitivity (SEN) and specificity, which could have contributed to the high variation of FDG PET/CT SEN in the context of IE diagnostics.. We assessed the diagnostic value of FDG PET/CT in a real-world cohort of patients with surgically managed infective endocarditis (IE)
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