Intérêt diagnostique de la TEP-TDM au 18F-FDG dans le diagnostic d’endocardite infectieuse sur valve native

Abstract

BackgroundNative valve endocarditis (NVE) is a rare but serious disease. The prognosis depends on the rapidity of diagnosis, and is currently based on modified Duke criteria, where echocardiography has a key role but may lack sensitivity if valves are calcified. For prosthetic valves, the European Society of Cardiology 2015 recommendations added 18F-FDG PET/CT as a major imaging criterion as well as for extension assessment. This study evaluated the diagnostic accuracy of 18F-FDG PET/CT in NVE and in extension assessment. MethodsThis retrospective study involved 59 patients suspected of NVE at Bordeaux university hospital between 2011 and 2019 and received 18F-FDG PET/CT. The final diagnosis was established according to Duke criteria after 3 months of management. Infective endocarditis (IE) was assessed in the initial phase according to the Duke criteria. All PET/CTs were blindly reviewed jointly by a junior and senior nuclear-medicine physician. ResultsIn total, 59 patients were included. At 3 months, 26 patients had definite IE, 22 had rejected IE, and 11 possible IE. Twelve patients had positive PET/CT results. The sensitivity of the modified Duke criteria in the initial phase was 77% and the specificity was 81%. When combined with 18F-FDG PET/CT, the sensitivity of the Duke criteria increased to 96% and the specificity was 81%. The sensitivity of 18F-FDG PET/CT alone was 46%. All three patients with perivalvular abscess had positive PET/CT results. Of the 22 patients with NVE definite at 3 months, fourteen (54%) had at least one septic embolism diagnosed on PET/CT. ConclusionsThe implementation of 18F-FDG PET/CT with modified Duke criteria increased the sensitivity for NVE diagnosis in the initial phase and contributed to IE extension assessment. It may contribute to making the diagnosis of a local cardiac complication.