Abstract
Purpose: PHV endocarditis is complicated by peri-annular extension (abscesses/mycotic aneurysms) in 50% of patients and has an in-hospital mortality of 30%. Transthoracic and Transesophageal Echocardiography (TTE and TEE) may fail to recognize peri-annular extensions, although this is an indication for urgent surgery. Therefore Computed Tomography Angiography (CTA) fused with 18F-Fluorodesoxyglucose Positron Emission Tomography (FDG-PET) may be of additional value. Methods: PHV patients that underwent FDG-PET were selected from the hospital database. CTA images were fused with FDG-PET images and the Standardized Uptake Value (SUV) ratio was measured. Imaging findings were compared to the reference standard: surgical inspection. Results: Eleven PHV endocarditis cases and four normal functioning PHV controls were identified. All cases and controls underwent TTE, TEE and CTA. In 11/11 (100%) endocarditis cases, imaging by fused FDG-PET and CTA detected high FDG uptake around the PHV. Surgical inspection confirmed peri-annular extension of endocarditis in all cases. Controls (n=4) were all free of significant FDG uptake. SUV ratios around the PHV ring were significantly (p=0.001) higher in endocarditis cases; 4.6 (IQR 3.8-5.1) compared to controls; 2.0 (IQR 1.7-2.1). SUV ratios around the PHV ring in cases were all above 2.6, whereas all controls had SUV ratio's below 2.3. ![Figure][1] A:TEE, B:CTA, C:Fused CTA and FDG-PET Conclusion: Fused cardiac FDG-PET and CTA imaging is a promising tool to correctly diagnose PHV endocarditis. SUV ratios may be used to discriminate PHV endocarditis with peri-annular extension from non-infected PHVs or PHVs endocarditis without peri-annular extension. Fused FDG-PET and CTA may be considered in patients with a high suspicion of PHV endocarditis but inconclusive routine work-up. [1]: pending:yes
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