Soile Pauliina Salomäki1, Antti Saraste2,3,4, Jukka Kemppainen2,5, Jeroen J Bax6, Juhani Knuuti2, Pirjo Nuutila1,2,4, Marko Seppänen2,5, Anne Roivainen2, Juhani Airaksinen3,4, Laura Pirilä1, Jarmo Oksi1,4, Ulla Hohenthal7. 1. Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland. 2. Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland. 3. Heart Center, University of Turku and Turku University Hospital, Turku, Finland. 4. Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland. 5. Department of Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland. 6. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 7. Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland. ulla.hohenthal@tyks.fi.
Abstract
BACKGROUND: The diagnosis of infective endocarditis (IE), especially the diagnosis of prosthetic valve endocarditis (PVE) is challenging since echocardiographic findings are often scarce in the early phase of the disease. We studied the use of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in IE. METHODS: Sixteen patients with suspected PVE and 7 patients with NVE underwent visual evaluation of 18F-FDG-PET/CT. 18F-FDG uptake was measured also semiquantitatively as maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). The modified Duke criteria were used as a reference. RESULTS: There was strong, focal 18F-FDG uptake in the area of the affected valve in all 6 cases of definite PVE, in 3 of 5 possible PVE cases, and in 2 of 5 rejected cases. In all patients with definite PVE, SUVmax of the affected valve was higher than 4 and TBR higher than 1.8. In contrast to PVE, only 1 of 7 patients with NVE had uptake of 18F-FDG by PET/CT in the valve area. Embolic infectious foci were detected in 58% of the patients with definite IE. CONCLUSIONS: 18F-FDG-PET/CT appears to be a sensitive method for the detection of paravalvular infection associated with PVE. Instead, the sensitivity of PET/CT is limited in NVE.
BACKGROUND: The diagnosis of infective endocarditis (IE), especially the diagnosis of prosthetic valve endocarditis (PVE) is challenging since echocardiographic findings are often scarce in the early phase of the disease. We studied the use of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in IE. METHODS: Sixteen patients with suspected PVE and 7 patients with NVE underwent visual evaluation of 18F-FDG-PET/CT. 18F-FDG uptake was measured also semiquantitatively as maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). The modified Duke criteria were used as a reference. RESULTS: There was strong, focal 18F-FDG uptake in the area of the affected valve in all 6 cases of definite PVE, in 3 of 5 possible PVE cases, and in 2 of 5 rejected cases. In all patients with definite PVE, SUVmax of the affected valve was higher than 4 and TBR higher than 1.8. In contrast to PVE, only 1 of 7 patients with NVE had uptake of 18F-FDG by PET/CT in the valve area. Embolic infectious foci were detected in 58% of the patients with definite IE. CONCLUSIONS:18F-FDG-PET/CT appears to be a sensitive method for the detection of paravalvular infection associated with PVE. Instead, the sensitivity of PET/CT is limited in NVE.
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