Abstract
BackgroundTo determine the normal perivalvular 18F-Fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography (PET) with computed tomography (CT) within one year after aortic prosthetic heart valve (PHV) implantation. MethodsPatients with uncomplicated aortic PHV implantation were prospectively included and underwent 18F-FDG PET/CT at either 5 (± 1) weeks (group 1), 12 (± 2) weeks (group 2) or 52 (± 8) weeks (group 3) after implantation. 18F-FDG uptake around the PHV was scored qualitatively (none/low/intermediate/high) and quantitatively by measuring the maximum Standardized Uptake Value (SUVmax) and target to background ratio (SUVratio). ResultsIn total, 37 patients (group 1: n = 12, group 2: n = 12, group 3: n = 13) (mean age 66 ± 8 years) were prospectively included. Perivalvular 18F-FDG uptake was low (8/12 (67%)) and intermediate (4/12 (33%)) in group 1, low (7/12 (58%)) and intermediate (5/12 (42%)) in group 2, and low (8/13 (62%)) and intermediate (5/13 (38%)) in group 3 (P = 0.91). SUVmax was 4.1 ± 0.7, 4.6 ± 0.9 and 3.8 ± 0.7 (mean ± SD, P = 0.08), and SUVratio was 2.0 [1.9 to 2.2], 2.0 [1.8 to 2.6], and 1.9 [1.7 to 2.0] (median [IQR], P = 0.81) for groups 1, 2, and 3, respectively. ConclusionNon-infected aortic PHV have similar low to intermediate perivalvular 18F-FDG uptake with similar SUVmax and SUVratio at 5, 12, and 52 weeks after implantation.
Highlights
To determine the normal perivalvular 18F-Fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography (PET) with computed tomography (CT) within one year after aortic prosthetic heart valve (PHV) implantation
The ESC guidelines suggest using 18F-FDG PET/CT only if the PHV was implanted [ 3 months prior to the scan because it was assumed that the normal healing response after aortic PHV implantation and its associated 18F-FDG uptake would cause false positive results and misinterpretations within this time window.[2]
No patient was suspected of having endocarditis prior to the PET/CT scan
Summary
Patients with uncomplicated aortic PHV implantation were prospectively included and underwent 18F-FDG PET/CT at either 5 (± 1) weeks (group 1), 12 (± 2) weeks (group 2) or 52 (± 8) weeks (group 3) after implantation. 18F-FDG uptake around the PHV was scored qualitatively (none/low/intermediate/high) and quantitatively by measuring the maximum Standardized Uptake Value (SUVmax) and target to background ratio (SUVratio). FDG PET/CT scans in PHV patients suspected for endocarditis, knowing the normal amount and pattern of 18F-FDG uptake around PHV’s (due to the normal tissue healing response) is important. The ESC guidelines suggest using 18F-FDG PET/CT only if the PHV was implanted [ 3 months prior to the scan because it was assumed that the normal healing response after aortic PHV implantation and its associated 18F-FDG uptake would cause false positive results and misinterpretations within this time window.[2] this arbitrary time period is not based on any evidence and has recently been questioned in other studies.[3,6] Indications of the normal 18F-FDG uptake patterns and cut-off values for abnormal uptake have been obtained from retrospective assessment of a limited number of patients with a PHV who underwent 18F-FDG PET/CT for indications other
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