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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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL (2015) 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European society of cardiology (ESC) endorsed by: european association for cardio-thoracic surgery (EACTS), the European association of nuclear medicine (EANM). Eur Heart J. doi:10.1093/eurheartj/ehv319
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30(4):633–638. doi:10.1086/313753
Hill EE, Herijgers P, Claus P, Vanderschueren S, Peetermans WE, Herregods MC (2007) Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study. Am Heart J 154(5):923–928. doi:10.1016/j.ahj.2007.06.028
Vieira ML, Grinberg M, Pomerantzeff PM, Andrade JL, Mansur AJ (2004) Repeated echocardiographic examinations of patients with suspected infective endocarditis. Heart 90(9):1020–1024. doi:10.1136/hrt.2003.025585
Bruun NE, Habib G, Thuny F, Sogaard P (2014) Cardiac imaging in infectious endocarditis. Eur Heart J 35(10):624–632. doi:10.1093/eurheartj/eht274
Fagman E, Perrotta S, Bech-Hanssen O, Flinck A, Lamm C, Olaison L, Svensson G (2012) ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis. Eur Radiol 22(11):2407–2414. doi:10.1007/s00330-012-2491-5
Habets J, Tanis W, van Herwerden LA, van den Brink RB, Mali WP, de Mol BA, Chamuleau SA, Budde RP (2014) Cardiac computed tomography angiography results in diagnostic and therapeutic change in prosthetic heart valve endocarditis. Int J Cardiovasc Imaging 30(2):377–387. doi:10.1007/s10554-013-0335-2
Prendergast BD, Tornos P (2010) Surgery for infective endocarditis: who and when? Circulation 121(9):1141–1152. doi:10.1161/CIRCULATIONAHA.108.773598
Jamar F, Buscombe J, Chiti A, Christian PE, Delbeke D, Donohoe KJ, Israel O, Martin-Comin J, Signore A (2013) EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med 54(4):647–658. doi:10.2967/jnumed.112.112524
Saby L, Laas O, Habib G, Cammilleri S, Mancini J, Tessonnier L, Casalta JP, Gouriet F, Riberi A, Avierinos JF, Collart F, Mundler O, Raoult D, Thuny F (2013) Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular 18F-fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol 61(23):2374–2382. doi:10.1016/j.jacc.2013.01.092
Ricciardi A, Sordillo P, Ceccarelli L, Maffongelli G, Calisti G, Di Pietro B, Caracciolo CR, Schillaci O, Pellegrino A, Chiariello L, Andreoni M, Sarmati L (2014) 18-Fluoro-2-deoxyglucose positron emission tomography-computed tomography: an additional tool in the diagnosis of prosthetic valve endocarditis. Int J Infect Dis. doi:10.1016/j.ijid.2014.04.028
Rouzet F, Chequer R, Benali K, Lepage L, Ghodbane W, Duval X, Iung B, Vahanian A, Le Guludec D, Hyafil F (2014) Respective performance of 18F-FDG PET and radiolabeled leukocyte scintigraphy for the diagnosis of prosthetic valve endocarditis. J Nucl Med 55(12):1980–1985. doi:10.2967/jnumed.114.141895
Pizzi MN, Roque A, Fernandez-Hidalgo N, Cuellar-Calabria H, Ferreira-Gonzalez I, Gonzalez-Alujas MT, Oristrell G, Gracia-Sanchez L, Gonzalez JJ, Rodriguez-Palomares J, Galinanes M, Maisterra-Santos O, Garcia-Dorado D, Castell-Conesa J, Almirante B, Aguade-Bruix S, Tornos P (2015) Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-FDG-PET/CT-angiography: initial results at an infective endocarditis referral center. Circulation. doi:10.1161/circulationaha.115.015316
Tanis W, Scholtens A, Habets J, van den Brink RB, van Herwerden LA, Chamuleau SA, Budde RP (2014) Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular 18F-fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol 63(2):186–187. doi:10.1016/j.jacc.2013.06.069
Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Cosyns B, Fox K, Aakhus S (2010) Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 11(2):202–219. doi:10.1093/ejechocard/jeq004
Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, Khandheria BK, Levine RA, Marx GR, Miller FA, Jr., Nakatani S, Quinones MA, Rakowski H, Rodriguez LL, Swaminathan M, Waggoner AD, Weissman NJ, Zabalgoitia M (2009) Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American society of echocardiography’s guidelines and standards committee and the task force on prosthetic valves. J Am Soc Echocardiogr 22 (9):975–1014; quiz 1082–1014. doi: 10.1016/j.echo.2009.07.013
Walther T, Autschbach R, Falk V, Baryalei M, Scheidt A, Dalichau H, Mohr FW (1996) The stentless Toronto SPV bioprosthesis for aortic valve replacement. Cardiovasc Surg 4(4):536–542
Jaskowiak CJ, Bianco JA, Perlman SB, Fine JP (2005) Influence of reconstruction iterations on 18F-FDG PET/CT standardized uptake values. J Nucl Med 46(3):424–428
Adams MC, Turkington TG, Wilson JM, Wong TZ (2010) A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol 195(2):310–320. doi:10.2214/AJR.10.4923
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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