Albert Roque1,2,3,4, María N Pizzi3,4,5,6, Nuria Fernández-Hidalgo3,4,7, Guillermo Romero-Farina4,5, Gemma Burcet1,2,3,4, José Luis Reyes-Juarez1,2,3,4, Carina Espinet2,3,8, Joan Castell-Conesa2,3,8, Manuel Escobar1,2, Ignacio Ferreira-González3,5,9, Santiago Aguadé-Bruix3,4,6,8, Hug Cuellar-Calabria1,2,3,4. 1. Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. 2. IDI (Institut de Diagnòstic per la Imatge), Barcelona, Spain. 3. Departament de Medicina, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. 4. Vall d'Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. 5. Department of Cardiology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. 6. Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. 7. Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. 8. Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. 9. CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Abstract
AIMS: Diagnosis of prosthetic valve endocarditis (PVE) by positron emission computed tomography angiography (PET/CTA) is based on visual and quantitative morpho-metabolic features. However, the fluorodeoxyglucose (FDG) uptake pattern can be sometimes visually unclear and susceptible to subjectivity. This study aimed to validate a new parameter, the valve uptake index [VUI, maximum standardized uptake value (SUVmax)-mean standardized uptake value (SUVmean)/SUVmax], designed to provide a more objective indication of the distribution of metabolic activity. Secondly, to re-evaluate the utility of traditionally used PVE imaging criteria and determine the potential value of adding the VUI in the diagnostic algorithm of PVE. METHODS AND RESULTS: Retrospective analysis of 122 patients (135 prosthetic valves) admitted for suspicion of endocarditis, with a conclusive diagnosis of definite (N = 57) or rejected (N = 65) PVE, and who had undergone a cardiac PET/CTA scan as part of the diagnostic evaluation. We measured the VUI and recorded the SUVmax, SUVratio, uptake pattern, and the presence of endocarditis-related anatomic lesions. The VUI, SUVmax, and SUVratio values were 0.54 ± 0.1 vs. 0.36 ± 0.08, 7.68 ± 3.07 vs. 3.72 ± 1.11, and 4.28 ± 1.93 vs. 2.16 ± 0.95 in the 'definite' PVE group vs. the 'rejected' group, respectively (mean ± SD; P < 0.001). A cut-off value of VUI > 0.45 showed a sensitivity, specificity, and diagnostic accuracy for PVE of 85%, 88%, and 86.7% and increased diagnostic ability for confirming endocarditis when combined with the standard diagnostic criteria. CONCLUSIONS: The VUI demonstrated good diagnostic accuracy for PVE, even increasing the diagnostic power of the traditionally used morphometabolic parameters, which also confirmed their own diagnostic performance. More research is needed to assess whether the integration of the VUI into the PVE diagnostic algorithm may clarify doubtful cases and thus improve the diagnostic yield of PET/CTA.
AIMS: Diagnosis of prosthetic valve endocarditis (PVE) by positron emission computed tomography angiography (PET/CTA) is based on visual and quantitative morpho-metabolic features. However, the fluorodeoxyglucose (FDG) uptake pattern can be sometimes visually unclear and susceptible to subjectivity. This study aimed to validate a new parameter, the valve uptake index [VUI, maximum standardized uptake value (SUVmax)-mean standardized uptake value (SUVmean)/SUVmax], designed to provide a more objective indication of the distribution of metabolic activity. Secondly, to re-evaluate the utility of traditionally used PVE imaging criteria and determine the potential value of adding the VUI in the diagnostic algorithm of PVE. METHODS AND RESULTS: Retrospective analysis of 122 patients (135 prosthetic valves) admitted for suspicion of endocarditis, with a conclusive diagnosis of definite (N = 57) or rejected (N = 65) PVE, and who had undergone a cardiac PET/CTA scan as part of the diagnostic evaluation. We measured the VUI and recorded the SUVmax, SUVratio, uptake pattern, and the presence of endocarditis-related anatomic lesions. The VUI, SUVmax, and SUVratio values were 0.54 ± 0.1 vs. 0.36 ± 0.08, 7.68 ± 3.07 vs. 3.72 ± 1.11, and 4.28 ± 1.93 vs. 2.16 ± 0.95 in the 'definite' PVE group vs. the 'rejected' group, respectively (mean ± SD; P < 0.001). A cut-off value of VUI > 0.45 showed a sensitivity, specificity, and diagnostic accuracy for PVE of 85%, 88%, and 86.7% and increased diagnostic ability for confirming endocarditis when combined with the standard diagnostic criteria. CONCLUSIONS: The VUI demonstrated good diagnostic accuracy for PVE, even increasing the diagnostic power of the traditionally used morphometabolic parameters, which also confirmed their own diagnostic performance. More research is needed to assess whether the integration of the VUI into the PVE diagnostic algorithm may clarify doubtful cases and thus improve the diagnostic yield of PET/CTA.
Authors: María N Pizzi; Albert Roque; Nuria Fernández-Hidalgo; Hug Cuéllar-Calabria; Ignacio Ferreira-González; María T Gonzàlez-Alujas; Gerard Oristrell; Laura Gracia-Sánchez; Juan J González; José Rodríguez-Palomares; Manuel Galiñanes; Olga Maisterra-Santos; David Garcia-Dorado; Joan Castell-Conesa; Benito Almirante; Santiago Aguadé-Bruix; Pilar Tornos Journal: Circulation Date: 2015-08-14 Impact factor: 29.690
Authors: Paola Anna Erba; Patrizio Lancellotti; Isidre Vilacosta; Oliver Gaemperli; Francois Rouzet; Marcus Hacker; Alberto Signore; Riemer H J A Slart; Gilbert Habib Journal: Eur J Nucl Med Mol Imaging Date: 2018-05-24 Impact factor: 9.236
Authors: Albert Roque; María N Pizzi; Nuria Fernández-Hidalgo; María Teresa González-Alujas; Remedios Ríos; Joan Castell-Conesa; Manuel Escobar; Ignacio Ferreira-González; Pilar Tornos; Santiago Aguadé-Bruix; Hug Cuellar-Calabria Journal: JACC Cardiovasc Imaging Date: 2020-01-15
Authors: Laurens E Swart; Asbjørn M Scholtens; Wilco Tanis; Koen Nieman; Ad J J C Bogers; Fred J Verzijlbergen; Gabriel P Krestin; Jolien W Roos-Hesselink; Ricardo P J Budde Journal: Eur Heart J Date: 2018-11-01 Impact factor: 29.983
Authors: Catherine M Otto; Rick A Nishimura; Robert O Bonow; Blase A Carabello; John P Erwin; Federico Gentile; Hani Jneid; Eric V Krieger; Michael Mack; Christopher McLeod; Patrick T O'Gara; Vera H Rigolin; Thoralf M Sundt; Annemarie Thompson; Christopher Toly Journal: Circulation Date: 2020-12-17 Impact factor: 29.690