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Clinical utility of 18F-FDG positron emission tomography/computed tomography scan vs. 99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis

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Abstract

The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether 18FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49–0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61–0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.

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Funding:

TKL was supported by a grant from the Danish Heart Foundation. DHF was not involved in the study design, the collection, analysis and interpretation of data, the writing of the report, or in the decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Cardiology, The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark

    Trine K. Lauridsen, Kasper K. Iversen, Nikolaj Ihlemann & Henning Bundgaard

  2. Cardiac Research Unit 2, Department of Cardiology, Herlev-Gentofte University Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark

    Trine K. Lauridsen & Anders Dahl

  3. Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark

    Philip Hasbak, Annika Loft, Anne K. Berthelsen, Danijela Dejanovic, Elisabeth Albrecht-Beste, Jann Mortensen & Andreas Kjær

  4. Department of Nuclear Medicine and Physiology, Herlev-Gentofte University Hospital, Hellerup, Denmark

    Elisabeth Albrecht-Beste

  5. Clinical Institute, Aalborg University, Aalborg, Denmark

    Niels Eske Bruun

  6. Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark

    Kasper K. Iversen & Niels Eske Bruun

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  1. Trine K. Lauridsen
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  2. Kasper K. Iversen
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Correspondence to Trine K. Lauridsen.

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Lauridsen, T.K., Iversen, K.K., Ihlemann, N. et al. Clinical utility of 18F-FDG positron emission tomography/computed tomography scan vs. 99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis. Int J Cardiovasc Imaging 33, 751–760 (2017). https://doi.org/10.1007/s10554-016-1047-1

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  • DOI: https://doi.org/10.1007/s10554-016-1047-1

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