Positron Emission Tomography/Computed Tomography for Diagnosis of Prosthetic Valve Endocarditis: Increased Valvular 18F-Fluorodeoxyglucose Uptake as a Novel Major Criteri

OBJECTIVES: We sought to determine the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for diagnosing prosthetic valve endocarditis (PVE). The diagnosis of PVE remains challenging. In PVE cases, initial echocardiography is normal or inconclusive in almost 30% of cases, leading to a decreased diagnostic accuracy for the modified Duke criteria.

METHODS: We prospectively studied 72 consecutive patients suspected of having PVE. All of the patients were subjected to clinical, microbiological, and echocardiographic evaluation. Cardiac PET/CT was performed at admission. The final diagnosis was defined according to the clinical and/or pathological modified Duke criteria determined during a 3-month follow-up.

RESULTS: A total of 36 (50%) patients exhibited abnormal FDG uptake around the site of the prosthetic valve. The sensitivity, specificity, positive predictive value, negative predictive value, and global accuracy were as follows (95% confidence interval): 73% (54%-87%), 80% (56%-93%), 85% (64%-95%), 67% (45%-84%), and 76% (63%-86%), respectively. Adding abnormal FDG uptake around the prosthetic valve as a new major criterion significantly increased the sensitivity of the modified Duke criteria at admission [70% (52%-83%) vs. 97% (83%-99%), p=0.008]. This result was due to a significant reduction (p<0.0001) in the number of possible PVE cases from 40 (56%) to 23 (32%).

CONCLUSIONS: The use of 18F-FDG PET/CT is helpful for diagnosing PVE. The results of this study support the addition of abnormal FDG uptake as a novel major criterion for PVE. 

PMID: 23583251

Posted in Echo, Nuclear Imaging and tagged , .

One Comment

  1. Great study!

    Prosthetic valve endocarditis can be difficult to confirm because the vegetations can be hard to see on echocardiography. Often you make the diagnosis based on high clinical suspicion, persistent positive blood cultures and a paravalvular abscess. A PET/CT scan could be a very useful test.

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