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18F-FDG PET/CT in the diagnosis of prosthetic valve endocarditis

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Abstract

Recent studies have shown promising results using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the diagnosis of prosthetic valve endocarditis (PVE). However, previous studies did not include negative controls. The aim of this study was to compare 18F-FDG-uptake around prosthetic aortic valves in patients with and without PVE and to determine the diagnostic performance of 18F-FDG PET/CT in the diagnosis of PVE. 18F-FDG PET/CT examinations in patients with a prosthetic aortic valve performed 2008–2014 were retrieved. Eight patients with a final diagnosis of definite PVE were included in the analysis of the diagnostic performance of 18F-FDG PET/CT. Examinations performed on suspicion of malignancy in patients without PVE (n = 19) were used as negative controls. Visual and semi-quantitative analysis was performed. Maximal standardized uptake value (SUVmax) in the valve area was measured and SUVratio was calculated by dividing valve SUVmax by SUVmax in the descending aorta. The sensitivity was 75 %, specificity 84 %, positive likelihood ratio [LR(+)] 4.8 and negative likelihood ratio [LR(−)] 0.3 on visual analysis. Both SUVmax and SUVratio were significantly higher in PVE patients [5.8 (IQR 3.5–6.5) and 2.4 (IQR 1.7–3.0)] compared to non-PVE patients [3.2 (IQR 2.8–3.8) and 1.5 (IQR 1.3–1.6)] (p < 0.001). ROC-curve analysis of SUVratio yielded an area under the curve of 0.90 (95 % CI 0.74–1.0). 18F-FDG-uptake around non-infected aortic prosthetic valves was low. The level of 18F-FDG-uptake in the prosthetic valve area showed a good diagnostic performance in the diagnosis of PVE.

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Authors and Affiliations

  1. Department of Radiology, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden

    Erika Fagman

  2. Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Erika Fagman

  3. Department of Clinical Physiology, Nuclear Medicine, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden

    Martijn van Essen & Johan Fredén Lindqvist

  4. Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Martijn van Essen, Johan Fredén Lindqvist, Odd Bech-Hanssen & Gunnar Svensson

  5. Department of Infectious Diseases, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden

    Ulrika Snygg-Martin

  6. Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Ulrika Snygg-Martin

  7. Department of Clinical Physiology, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden

    Odd Bech-Hanssen

  8. Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden

    Gunnar Svensson

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  1. Erika Fagman
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  2. Martijn van Essen
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Correspondence to Erika Fagman.

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Fagman, E., van Essen, M., Fredén Lindqvist, J. et al. 18F-FDG PET/CT in the diagnosis of prosthetic valve endocarditis. Int J Cardiovasc Imaging 32, 679–686 (2016). https://doi.org/10.1007/s10554-015-0814-8

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  • DOI: https://doi.org/10.1007/s10554-015-0814-8

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