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18F-FDG positron emission tomography/computed tomography in infective endocarditis

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The diagnosis of infective endocarditis (IE), especially the diagnosis of prosthetic valve endocarditis (PVE) is challenging since echocardiographic findings are often scarce in the early phase of the disease. We studied the use of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in IE.

Methods

Sixteen patients with suspected PVE and 7 patients with NVE underwent visual evaluation of 18F-FDG-PET/CT. 18F-FDG uptake was measured also semiquantitatively as maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). The modified Duke criteria were used as a reference.

Results

There was strong, focal 18F-FDG uptake in the area of the affected valve in all 6 cases of definite PVE, in 3 of 5 possible PVE cases, and in 2 of 5 rejected cases. In all patients with definite PVE, SUVmax of the affected valve was higher than 4 and TBR higher than 1.8. In contrast to PVE, only 1 of 7 patients with NVE had uptake of 18F-FDG by PET/CT in the valve area. Embolic infectious foci were detected in 58% of the patients with definite IE.

Conclusions

18F-FDG-PET/CT appears to be a sensitive method for the detection of paravalvular infection associated with PVE. Instead, the sensitivity of PET/CT is limited in NVE.

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Abbreviations

IE:

Infective endocarditis

PVE:

Prosthetic valve endocarditis

NVE:

Native valve endocarditis

PET/CT:

Positron emission tomography/computed tomography

18F-FDG:

2[18F]fluoro-2-deoxy-D-glucose

SUVmax :

Maximum standardized uptake value

TBR:

Target-to-background ratio

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

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Acknowledgement

The study was conducted in the Finnish Centre of Excellence in Cardiovascular and Metabolic Diseases supported by the Academy of Finland, University of Turku, Turku University Hospital, and Åbo Akademi University. The study was supported by the State Research Funds of the Turku University Hospital, and Orion-Farmos Research Foundation.

Disclosure

The authors have no conflicts of interest to report.

Author information

Authors and Affiliations

  1. Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland

    Soile Pauliina Salomäki MD, Pirjo Nuutila MD, PhD, Laura Pirilä MD, PhD, Jarmo Oksi MD, PhD & Ulla Hohenthal MD, PhD

  2. Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland

    Antti Saraste MD, PhD, Jukka Kemppainen MD, PhD, Juhani Knuuti MD, PhD, Pirjo Nuutila MD, PhD, Marko Seppänen MD, PhD & Anne Roivainen PhD

  3. Heart Center, University of Turku and Turku University Hospital, Turku, Finland

    Antti Saraste MD, PhD & Juhani Airaksinen MD, PhD

  4. Department of Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland

    Jukka Kemppainen MD, PhD & Marko Seppänen MD, PhD

  5. Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland

    Antti Saraste MD, PhD, Pirjo Nuutila MD, PhD, Juhani Airaksinen MD, PhD & Jarmo Oksi MD, PhD

  6. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

    Jeroen J. Bax MD, PhD

Authors
  1. Soile Pauliina Salomäki MD
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  2. Antti Saraste MD, PhD
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  3. Jukka Kemppainen MD, PhD
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  4. Jeroen J. Bax MD, PhD
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  5. Juhani Knuuti MD, PhD
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  6. Pirjo Nuutila MD, PhD
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  8. Anne Roivainen PhD
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  9. Juhani Airaksinen MD, PhD
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  10. Laura Pirilä MD, PhD
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  11. Jarmo Oksi MD, PhD
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  12. Ulla Hohenthal MD, PhD
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Corresponding author

Correspondence to Ulla Hohenthal MD, PhD.

Additional information

See related editorial, doi: 10.1007/s12350-015-0369-z.

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Salomäki, S.P., Saraste, A., Kemppainen, J. et al. 18F-FDG positron emission tomography/computed tomography in infective endocarditis. J. Nucl. Cardiol. 24, 195–206 (2017). https://doi.org/10.1007/s12350-015-0325-y

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  • DOI: https://doi.org/10.1007/s12350-015-0325-y

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