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New criteria for the diagnosis of infective endocarditis using 18F-FDG PET/CT imaging

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Journal of Nuclear Cardiology Aims and scope

A Correction to this article was published on 11 February 2022

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Abstract

Objectives

The purpose of this study was to examine a qualitative scoring system and a semi-quantitative method of FDG-PET/CT imaging in the diagnosis of infective endocarditis (IE).

Methods

We retrospectively included 108 patients who underwent 18F-FDG-PET/CT for suspected IE. PET/CT scans were interpreted using a 4-point score (0 = no uptake; 1 = cardiac uptake < blood-pool activity; 2 = blood-pool < uptake < liver activity; 3 = uptake > liver) and semi-quantitatively using SUVmax and SUVmean of the suspected valve lesion, liver, spleen, and of the bone marrow (BM). BM and spleen SUVmean were normalized to the liver, and hypermetabolism (HSBM) was defined as a BM or spleen-to-liver ratio > 1.

Results

Comparing the score criteria results with the clinical final diagnosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of qualitative criteria were 93%, 81%, 84%, 91%, and 87%, respectively. A definite IE was documented in 83% of patients showing HSBM and abnormal cardiac uptake, 44% with abnormal cardiac uptake, 28% with HSBM, and 10% with neither one.

Conclusion

The qualitative scoring system is helpful in the diagnosis of IE. The HSBM is an additional, reliable indirect sign of IE.

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Change history

Abbreviations

IE:

Infective endocarditis

PVE:

Prosthetic heart valve endocarditis

CIED:

Cardiac implantable electronic device

NVE:

Native valve endocarditis

ICD:

Indwelling cardiac device

ESC:

European Society of Cardiology

BM:

Bone marrow

HSBM:

Hypermetabolism of spleen and/or bone marrow

LCHPHF:

Low-carbohydrate, high-protein and high-fat diet

NAC:

Non-attenuation correction

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Authors and Affiliations

  1. Nuclear Medicine, Spedali Civili, Brescia, Italy

    Maria Gazzilli MD, Silvia Lucchini MD, Alessia Peli MD & Elisabetta Cerudelli MD

  2. Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy

    Domenico Albano MD, Francesco Bertagna MD & Raffaele Giubbini MD

  3. Nuclear Medicine, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy

    Maria Gazzilli MD

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  1. Maria Gazzilli MD
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  2. Domenico Albano MD
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  3. Silvia Lucchini MD
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  4. Alessia Peli MD
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  5. Elisabetta Cerudelli MD
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  6. Francesco Bertagna MD
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  7. Raffaele Giubbini MD
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Correspondence to Maria Gazzilli MD.

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Gazzilli, M., Albano, D., Lucchini, S. et al. New criteria for the diagnosis of infective endocarditis using 18F-FDG PET/CT imaging. J. Nucl. Cardiol. 29, 2188–2194 (2022). https://doi.org/10.1007/s12350-021-02663-1

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  • DOI: https://doi.org/10.1007/s12350-021-02663-1

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