Abstract
Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac valve) and the search of secondary systemic complications. Early depiction of local complications or distant embolization has a great impact on patient management and prognosis, as it may induce to aggressive antibiotic treatment or, in more advanced cases, cardiac surgery. In this setting, the multimodality imaging has assumed a pivotal role in the clinical decision making and it requires the physician to be aware of the advantages and disadvantages of each imaging technique. Echocardiography is the first imaging test, but it has several limitations. Therefore, the integration with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) becomes often necessary. Different strategies should be applied depending on whether the infection is suspected or already ascertained, whether located in native or prosthetic valves, in the left or right chambers, or if it involves an implanted cardiac device. In addition, detection of extracardiac IE-related lesions is crucial for a correct management and treatment. The aim of this review is to illustrate strengths and weaknesses of the various methods in the most common clinical scenarios.
Highlights
Infective endocarditis (IE) is a complex pathological entity with various clinical presentations, whose diagnosis may be challenging as based on a combination of multiple clinical, biological, and imaging criteria [1,2]
Abnormal activity around the prosthetic valve detected by fluoro-18-fluorodeoxyglucose ((18F)FDG) positron emission tomography/computed tomography (PET/CT) or radiolabeled white blood cells (WBC) scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) is considered a major criterion for the diagnosis of IE according to European Society of Cardiology (ESC) guidelines published in 2015
A pivotal aspect of this approach is represented by the “Endocarditis Team” that involves cardiologists, cardiac surgeons, imaging specialists, microbiologists, infective diseases specialists, neurosurgeons, and other specialists involved in a case-by-case scenario, each one with his or her specific expertise and competence, aiming to ensure best management for the patients, especially in complicated scenarios
Summary
Infective endocarditis (IE) is a complex pathological entity with various clinical presentations, whose diagnosis may be challenging as based on a combination of multiple clinical, biological, and imaging criteria [1,2]. The key elements for disease characterization are to identify the pathogen in the blood, to detect vegetation on the cardiac valves (native or prosthetic) or adhering to CIED, and to assess local complication or distant embolization. In this perspective, the choice of the most appropriate diagnostic imaging tool can play a crucial role in both confirming the diagnosis and guiding the treatment. The aim of the present review was to provide an overview of the pros and cons of the different imaging techniques to answer specific questions in the most common clinical scenarios
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