Skip to main content

Advertisement

SpringerLink
Log in

Clinical usefulness of FDG-PET/CT for identification of abnormal extra-cardiac foci in patients with infective endocarditis

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The aim of the study was to evaluate the ability to detect extra-cardiac foci by means of whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in patients with definite endocarditis (IE) according to the modified Duke criteria and investigate the clinical impact of the findings. From January 2011 to December 2015 we included 178 patients (mean age 66 ± 14 years, 25% female) with IE in this multicentre study. FDG-PET/CT was part of the work-up for extra-cardiac foci in the including hospitals and was performed at a median of 9 days (IQR 10) after IE was diagnosed. In 114 patients FDG-PET/CT identified 166 lesions: 52 (31%) infectious lesions, 21 (13%) cases of cancer, 7 (4%) cases of embolism, 60 (36%) reactive findings, and 26 (16%) other types of lesions. A total of 74 new extra-cardiac findings, not previously discovered by other modalities, were identified in 62 patients and resulted in additional investigations in 29 patients and a change in treatment in 18 patients (10%). The most frequent diagnoses discovered by FDG-PET/CT were colon polyps, cancer, and spondylodiscitis. There was a higher rate of findings leading to a change in treatment in patients above 67 years of age infected with other bacterial aetiologies than streptococci. FDG-PET/CT was useful to detect extra-cardiac foci. FDG-PET/CT findings may lead to unnecessary investigations. One out of 10 the patients with definite endocarditis had underwent a change in treatment regimen based on the FDG-PET/CT findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Moreillon P, Que YA (2004) Infective endocarditis. Lancet 363:139–149

    Article  Google Scholar 

  2. Bonfiglioli R, Nanni C, Morigi JJ, Graziosi M, Trapani F, Bartoletti M, Tumietto F, Ambrosini V, Ferretti A, Rubello D, Rapezzi C, Viale PL, Fanti S (2013) 18F-FDG PET/CT diagnosis of unexpected extracardiac septic embolisms in patients with suspected cardiac endocarditis. Eur J Nucl Med Mol Imaging 40:1190–1196

    Article  CAS  Google Scholar 

  3. Rizzi M, Ravasio V, Carobbio A, Mattucci I, Crapis M, Stellini R, Pasticci MB, Chinello P, Falcone M, Grossi P, Barbaro F, Pan A, Viale P, Durante-Mangoni E (2014) Predicting the occurrence of embolic events: an analysis of 1456 episodes of infective endocarditis from the Italian Study on Endocarditis (SEI). BMC Infect Dis 14:230

    Article  Google Scholar 

  4. Misra DP, Chowdury AC, Edavalath S, Aggarwal A, Kumar S, Agarwal V (2016) Endocarditis: the great mimic of rheumatic diseases. Trop Doct 46:180–186

    Article  Google Scholar 

  5. Koslow M, Kuperstein R, Eshed I, Perelman M, Maor E, Sidi Y (2014) The unique clinical features and outcome of infectious endocarditis and vertebral osteomyelitis co-infection. Am J Med 127:669

    Article  Google Scholar 

  6. Fabri J Jr, Issa VS, Pomerantzeff PM, Grinberg M, Barretto AC, Mansur AJ (2006) Time-related distribution, risk factors and prognostic influence of embolism in patients with left-sided infective endocarditis. Int J Cardiol 110:334–339

    Article  Google Scholar 

  7. Thuny F, Di Salvo G, Belliard O, Avierinos J-F, Pergola V, Rosenberg V, Casalta J-P, Gouvernet J, Derumeaux G, Iarussi D, Ambrosi P, Calabro R, Riberi A, Colart F, Metras D, Lepidi H, Raoult D, Harle J-R, Weiller P-J, Cohen A, Habib G (2005) Risk of embolism and death in infective endocarditis: prognostic value of echocardiography. A prospective multicenter study. Circulation 112:69–75

    Article  Google Scholar 

  8. Chu VH, Cabell CH, Benjamin DK Jr, Kuniholm EF, Fowler VG Jr, Engemann J, Sexton DJ, Corey R, Wang A (2004) Early predictors of in-hospital death in infective endocarditis. Circulation 109:1745–1749

    Article  Google Scholar 

  9. Millar BC, Habib G, Moore JE (2016) New diagnostic approaches in infective endocarditis. Heart 102:796–807

    Article  Google Scholar 

  10. Meller J, Sahlmann CO, Scheel AK (2007) 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med 48:35–45

    CAS  PubMed  Google Scholar 

  11. Bleeker-Rovers CP, de Kleijn EM, Corstens FH, van der Meer JW, Oyen WJ (2004) Clinical value of FDGPET in patients with fever of unknown origin and patients suspected of focal infection or inflammation. Eur J Nucl Med Mol Imaging 31:29–37

    Article  Google Scholar 

  12. Ozcan C, Asmar A, Gill S, Thomassen A, Diederichsen AC (2013) The value of FDG-PET/CT in the diagnostic work-up of extra cardiac infectious manifestations in infectious endocarditis. Int J Cardiovasc Imaging 29:1629–1637

    Article  CAS  Google Scholar 

  13. Van RJ, Hill EE, Gheysens O, Dymarkowski S, Herregods MC, Herijgers P, Peetermans WE, Mortelmans L (2010) (18)F-FDG PET/CT for early detection of embolism and metastatic infection in patients with infective endocarditis. Eur J Nucl Med Mol Imaging 37:1189–1197

    Article  Google Scholar 

  14. Amraoui S, Tlili G, Sohal M, Berte B, Hindie E, Ritter P, Ploux S, Denis A, Derval N, Rinaldi CA, Cazanave C, Jais P, Haissaguerre M, Bordenave L, Bordachar P (2016) Contribution of PET imaging to the diagnosis of septic embolism in patients with pacing lead endocarditis. JACC Cardiovasc Imaging 9:283–290

    Article  Google Scholar 

  15. 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) ESC Guidelines for the management of infective endocarditis. The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)

  16. Gomes A, Glaudemans AW, Touw DJ, Van MJP, Willems TP, Maass AH, Natour E, Prakken NH, Borra RJ, Van GPP, Slart RH, Van AS, Sinha B (2017) Diagnostic value of imaging in infective endocarditis: a systematic review. Lancet Infect Dis 17:1–14

    Article  Google Scholar 

  17. Chen W, Dilsizian V (2019) FDG PET/CT for the diagnosis and management of infective endocarditis: expert consensus vs evidence-based practice. J Nucl Cardiol 26:313–315

    Article  Google Scholar 

  18. Asmar A, Ozcan C, Diederichsen AC, Thomassen A, Gill S (2014) Clinical impact of 18F-FDG-PET/CT in the extra cardiac work-up of patients with infective endocarditis. Eur Heart J Cardiovasc Imaging 15:1013–1019

    Article  Google Scholar 

  19. Lauridsen T, Iversen KK, Ihlemann N, Hasbak P, Loft A, Berthelsen AK, Dahl A, Dejanovic D, Albrecht-Beste E, Mortensen J, Kjaer A, Bundgaard H, Bruun NE (2017) 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

    Article  Google Scholar 

  20. Kestler M, Munoz P, Rodriguez-Creixems M, Rotger A, Jimenez-Requena F, Mari A, Orcajo J, Hernandez L, Alonso JC, Bouza E (2014) Role of (18)F-FDG PET in PATIENTS WITH INFECTIOUS ENDOCARDITIS. J Nucl Med 55:1093–1098

    Article  CAS  Google Scholar 

  21. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus AM, Thilen U, Lekakis J, Lengyel M, Muller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL (2009) Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 30:2369–2413

    Article  Google Scholar 

  22. Smids C, Kouijzer IJ, Vos FJ, Sprong T, Hosman AJ, de Rooy JW, Aarntzen EH, de Geus-Oei LF, Oyen WJ, Bleeker-Rovers CP (2017) A comparison of the diagnostic value of MRI and 18F-FDG-PET/CT in suspected spondylodiscitis. Infection 45:41–49

    Article  Google Scholar 

  23. Fuster D, Tomas X, Mayoral M, Soriano A, Manchon F, Cardenal C, Monegal A, Granados U, Garcia S, Pons F (2015) Prospective comparison of whole-body (18)F-FDG PET/CT and MRI of the spine in the diagnosis of haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging 42:264–271

    Article  CAS  Google Scholar 

  24. Delahaye F, M’Hammedi A, Guerpillon B, de Gevigney G, Boibieux A, Dauwalder O, Bouchiat C, Vandenesch F (2016) Systematic search for present and potential portals of entry for infective endocarditis. J Am Coll Cardiol 67:151–158

    Article  Google Scholar 

  25. Tong J, Zou Y, Jiang J, Shi W, Tao R, Ye J, Lu Y, Jiang X, Wang W (2016) Cancer screening of asymptomatic individuals using 18F-FDG PET/CT in China: a retrospective study. Discov Med 22:181–188

    PubMed  Google Scholar 

  26. Minamimoto R, Senda M, Jinnouchi S, Terauchi T, Yoshida T, Murano T, Fukuda H, Iinuma T, Uno K, Nishizawa S, Tsukamoto E, Iwata H, Inoue T, Oguchi K, Nakashima R, Inoue T (2013) The current status of an FDG-PET cancer screening program in Japan, based on a 4-year (2006–2009) nationwide survey. Ann Nucl Med 27:46–57

    Article  Google Scholar 

  27. 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 55:1980–1985

    Article  CAS  Google Scholar 

  28. Swart LE, Gomes A, Scholtens AM, Sinha B, Tanis W, Lam MGEH, van der Vlugt MJ, Streukens SAF, Aarntzen EHJG, Bucerius J, van Assen S, Bleeker-Rovers CP, van Geel PP, Krestin GP, van Melle JP, Roos-Hesselink JW, Slart RHJA, Glaudemans AWJM, Budde RPJ (2018) Improving the diagnostic performance of 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography in prosthetic heart valve endocarditis. Circulation 138:1412–1427

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Henning Bundgaard and Kasper Karmark Iversen have shared last authorship.

Authors and Affiliations

  1. Department of Cardiology, Herlev Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark

    Sarah Louise Kjølhede Holle, Malene Højgaard Andersen, Christine Falk Klein, Christian Haarmark & Kasper Karmark Iversen

  2. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Annika Loft & Henning Bundgaard

  3. Department of Cardiology, Herlev Gentofte Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark

    Niels Eske Bruun

  4. Department of Cardiology, Dyrehavevej 29, 3400, Hillerød, Denmark

    Niels Tønder

  5. Department of Nuclear Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark

    Poul Flemming Høilund-Carlsen

Authors
  1. Sarah Louise Kjølhede Holle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Malene Højgaard Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine Falk Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Niels Eske Bruun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Niels Tønder
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian Haarmark
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Annika Loft
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Poul Flemming Høilund-Carlsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Henning Bundgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kasper Karmark Iversen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah Louise Kjølhede Holle.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Holle, S.L.K., Andersen, M.H., Klein, C.F. et al. Clinical usefulness of FDG-PET/CT for identification of abnormal extra-cardiac foci in patients with infective endocarditis. Int J Cardiovasc Imaging 36, 939–946 (2020). https://doi.org/10.1007/s10554-020-01787-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-020-01787-8

Keywords

Search

Navigation