Laurens E Swart1,2, Anna Gomes3, Asbjørn M Scholtens4, Bhanu Sinha3, Wilco Tanis5, Marnix G E H Lam6, Maureen J van der Vlugt7, Sebastian A F Streukens8, Erik H J G Aarntzen9, Jan Bucerius10,11,12, Sander van Assen13, Chantal P Bleeker-Rovers14, Peter Paul van Geel15, Gabriel P Krestin1, Joost P van Melle15, Jolien W Roos-Hesselink2, Riemer H J A Slart16,17, Andor W J M Glaudemans16, Ricardo P J Budde1. 1. Department of Radiology and Nuclear Medicine (L.E.S., G.P.K., R.P.J.B.), Erasmus Medical Center, Rotterdam, The Netherlands. 2. Department of Cardiology (L.E.S., J.W.R.-H.), Erasmus Medical Center, Rotterdam, The Netherlands. 3. Department of Medical Microbiology (A.G., B.S.), University of Groningen, University Medical Center Groningen, The Netherlands. 4. Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands (A.M.S.). 5. Heartcenter, Haga Teaching Hospital, The Hague, The Netherlands (W.T.). 6. Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, The Netherlands (M.G.E.H.L.). 7. Department of Cardiology (M.J.v.d.V.), Radboud University Medical Center, Nijmegen, The Netherlands. 8. Department of Cardiology (S.A.F.S.), Maastricht University Medical Center, The Netherlands. 9. Department of Radiology and Nuclear Medicine (E.H.J.G.A.), Radboud University Medical Center, Nijmegen, The Netherlands. 10. Department of Radiology and Nuclear Medicine (J.B.), Maastricht University Medical Center, The Netherlands. 11. Cardiovascular Research Institute Maastricht (J.B.), Maastricht University Medical Center, The Netherlands. 12. Department of Nuclear Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Germany (J.B.). 13. Department of Internal Medicine, Treant Care Group, Hoogeveen/Emmen/Stadskanaal, The Netherlands (S.v.A.). 14. Department of Internal Medicine (C.P.B.-R.), Radboud University Medical Center, Nijmegen, The Netherlands. 15. Department of Cardiology (P.P.v.G., J.P.v.M.), University of Groningen, University Medical Center Groningen, The Netherlands. 16. Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center (R.H.J.A.S., A.W.J.M.G.), University of Groningen, University Medical Center Groningen, The Netherlands. 17. Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands (R.H.J.A.S.).
Abstract
BACKGROUND: 18F-Fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) was recently introduced as a new tool for the diagnosis of prosthetic heart valve endocarditis (PVE). Previous studies reporting a modest diagnostic accuracy may have been hampered by unstandardized image acquisition and assessment, and several confounders, as well. The aim of this study was to improve the diagnostic performance of FDG PET/CT in patients in whom PVE was suspected by identifying and excluding possible confounders, using both visual and standardized quantitative assessments. METHODS: In this multicenter study, 160 patients with a prosthetic heart valve (median age, 62 years [43-73]; 68% male; 82 mechanical valves; 62 biological; 9 transcatheter aortic valve replacements; 7 other) who underwent FDG PET/CT for suspicion of PVE, and 77 patients with a PV (median age, 73 years [65-77]; 71% male; 26 mechanical valves; 45 biological; 6 transcatheter aortic valve replacements) who underwent FDG PET/CT for other indications (negative control group), were retrospectively included. Their scans were reassessed by 2 independent observers blinded to all clinical data, both visually and quantitatively on available European Association of Nuclear Medicine Research Ltd-standardized reconstructions. Confounders were identified by use of a logistic regression model and subsequently excluded. RESULTS: Visual assessment of FDG PET/CT had a sensitivity/specificity/positive predictive value/negative predictive value for PVE of 74%/91%/89%/78%, respectively. Low inflammatory activity (C-reactive protein <40 mg/L) at the time of imaging and use of surgical adhesives during prosthetic heart valve implantation were significant confounders, whereas recent valve implantation was not. After the exclusion of patients with significant confounders, diagnostic performance values of the visual assessment increased to 91%/95%/95%/91%. As a semiquantitative measure of FDG uptake, a European Association of Nuclear Medicine Research Ltd-standardized uptake value ratio of ≥2.0 was a 100% sensitive and 91% specific predictor of PVE. CONCLUSIONS: Both visual and quantitative assessments of FDG PET/CT have a high diagnostic accuracy in patients in whom PVE is suspected. FDG PET/CT should be implemented early in the diagnostic workup to prevent the negative confounding effects of low inflammatory activity (eg, attributable to prolonged antibiotic therapy). Recent valve implantation was not a significant predictor of false-positive interpretations, but surgical adhesives used during implantation were.
BACKGROUND:18F-Fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) was recently introduced as a new tool for the diagnosis of prosthetic heart valve endocarditis (PVE). Previous studies reporting a modest diagnostic accuracy may have been hampered by unstandardized image acquisition and assessment, and several confounders, as well. The aim of this study was to improve the diagnostic performance of FDG PET/CT in patients in whom PVE was suspected by identifying and excluding possible confounders, using both visual and standardized quantitative assessments. METHODS: In this multicenter study, 160 patients with a prosthetic heart valve (median age, 62 years [43-73]; 68% male; 82 mechanical valves; 62 biological; 9 transcatheter aortic valve replacements; 7 other) who underwent FDG PET/CT for suspicion of PVE, and 77 patients with a PV (median age, 73 years [65-77]; 71% male; 26 mechanical valves; 45 biological; 6 transcatheter aortic valve replacements) who underwent FDG PET/CT for other indications (negative control group), were retrospectively included. Their scans were reassessed by 2 independent observers blinded to all clinical data, both visually and quantitatively on available European Association of Nuclear Medicine Research Ltd-standardized reconstructions. Confounders were identified by use of a logistic regression model and subsequently excluded. RESULTS: Visual assessment of FDG PET/CT had a sensitivity/specificity/positive predictive value/negative predictive value for PVE of 74%/91%/89%/78%, respectively. Low inflammatory activity (C-reactive protein <40 mg/L) at the time of imaging and use of surgical adhesives during prosthetic heart valve implantation were significant confounders, whereas recent valve implantation was not. After the exclusion of patients with significant confounders, diagnostic performance values of the visual assessment increased to 91%/95%/95%/91%. As a semiquantitative measure of FDG uptake, a European Association of Nuclear Medicine Research Ltd-standardized uptake value ratio of ≥2.0 was a 100% sensitive and 91% specific predictor of PVE. CONCLUSIONS: Both visual and quantitative assessments of FDG PET/CT have a high diagnostic accuracy in patients in whom PVE is suspected. FDG PET/CT should be implemented early in the diagnostic workup to prevent the negative confounding effects of low inflammatory activity (eg, attributable to prolonged antibiotic therapy). Recent valve implantation was not a significant predictor of false-positive interpretations, but surgical adhesives used during implantation were.
Authors: Rudolf A Werner; James T Thackeray; Johanna Diekmann; Desiree Weiberg; Johann Bauersachs; Frank M Bengel Journal: J Nucl Med Date: 2020-04-17 Impact factor: 11.082
Authors: Andreas Seraphim; Mark Westwood; Anish N Bhuva; Tom Crake; James C Moon; Leon J Menezes; Guy Lloyd; Arjun K Ghosh; Sarah Slater; Heather Oakervee; Charlotte H Manisty Journal: Curr Treat Options Oncol Date: 2019-08-08
Authors: S El Kadi; D M F van den Buijs; T Meijers; M D Gilbers; S C A M Bekkers; J P van Melle; R K Riezebos; W L Blok; W Tanis; A R Wahadat; J W Roos-Hesselink; T I G van der Spoel; S A J Chamuleau; O Kamp Journal: Neth Heart J Date: 2020-10 Impact factor: 2.854
Authors: Riemer H J A Slart; Andor W J M Glaudemans; Olivier Gheysens; Mark Lubberink; Tanja Kero; Marc R Dweck; Gilbert Habib; Oliver Gaemperli; Antti Saraste; Alessia Gimelli; Panagiotis Georgoulias; Hein J Verberne; Jan Bucerius; Christoph Rischpler; Fabien Hyafil; Paola A Erba Journal: Eur Heart J Cardiovasc Imaging Date: 2020-12-01 Impact factor: 6.875