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Assessment of the diagnostic accuracy of 18F-FDG PET/CT in prosthetic infective endocarditis and cardiac implantable electronic device infection: comparison of different interpretation criteria

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The diagnosis of prosthetic valve (PV) infective endocarditis (IE) and infection of cardiac implantable electronic devices (CIEDs) remains challenging. The aim of this study was to assess the usefulness of 18F-FDG PET/CT in these patients and analyse the interpretation criteria.

Methods

We included 41 patients suspected of having IE by the Duke criteria who underwent 18F-FDG PET/CT. The criteria applied for classifying the findings as positive/negative for IE were: (a) visual analysis of only PET images with attenuation-correction (AC PET images); (b) visual analysis of both AC PET images and PET images without AC (NAC PET images); (c) qualitative analysis of NAC PET images; and (d) semiquantitative analysis of AC PET images. 18F-FDG PET/CT was considered positive for IE independently of the intensity and distribution of FDG uptake. The gold standard was the Duke pathological criteria (if tissue was available) or the decision of an endocarditis expert team after a minimum 4 months follow-up.

Results

We studied 62 areas with suspicion of IE, 28 areas (45 %) showing definite IE and 34 (55 %) showing possible IE. Visual analysis of only AC PET images showed poor diagnostic accuracy (sensitivity 20 %, specificity 57 %). Visual analysis of both AC PET and NAC PET images showed excellent sensitivity (100 %) and intermediate specificity (73 %), focal uptake being more frequently associated with IE. The accuracy of qualitative analysis of NAC PET images depended on the threshold: the maximum sensitivity, specificity and accuracy achieved were 88 %, 80 %, 84 %, respectively. In the semiquantitative analysis of AC PET images, SUVmax was higher in areas of confirmed IE than in those without IE (∆SUVmax 2.2, p < 0.001). When FDG uptake was twice that in the liver, IE was always confirmed, and SUVmax 5.5 was the optimal threshold for IE diagnosis using ROC curve analysis (area under the curve 0.71).

Conclusion

The value of 18F-FDG PET/CT in the diagnosis of suspected IE of PVs and CIEDs is highly dependent on patient preparation and the method used for image interpretation. Based on our results, the best method is to consider a study positive for IE when FDG uptake is present in both AC PET and NAC PET images.

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References

  1. Moreillon P, Que YA. Infective endocarditis. Lancet. 2004;363:139–49.

    Article  PubMed  Google Scholar 

  2. Habib G, Thuny F, Avierinos JF. Prosthetic valve endocarditis: current approach and therapeutic options. Prog Cardiovasc Dis. 2008;50:274–81.

    Article  PubMed  Google Scholar 

  3. Uslan DZ, Sohail MR, Sauver JL, Friedman PA, Hayes DL, Stoner SM, et al. Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med. 2007;167:669–75.

    Article  PubMed  Google Scholar 

  4. Uslan DZ, Tleyjeh IM, Baddour LM, Friedman PA, Jenkins SM, Sauver JL, et al. Temporal trends in permanent pacemaker implantation: a population-based study. Am Heart J. 2008;155:896–903.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010;121:458–77.

    Article  PubMed  Google Scholar 

  6. Li JS, Sexton DJ, Mick N, Nettles R, Fowler Jr VG, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.

    Article  CAS  PubMed  Google Scholar 

  7. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 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. 2015;36:3075–128.

  8. Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.

    Article  CAS  PubMed  Google Scholar 

  9. Jamar F, Buscombe J, Chiti A, Christian PE, Delbeke D, Donohoe KJ, et al. EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med. 2013;54:647–58.

    Article  PubMed  Google Scholar 

  10. Chen W, Kim J, Molchanova-Cook OP, Dilsizian V. The potential of FDG PET/CT for early diagnosis of cardiac device and prosthetic valve infection before morphologic damages ensue. Curr Cardiol Rep. 2014;16:459.

    Article  PubMed  Google Scholar 

  11. Saby L, Laas O, Habib G, Cammilleri S, Mancini J, Tessonnier L, et al. 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. 2013;61:2374–82.

    Article  PubMed  Google Scholar 

  12. Millar BC, Prendergast BD, Alavi A, Moore JE. 18FDG-positron emission tomography (PET) has a role to play in the diagnosis and therapy of infective endocarditis and cardiac device infection. Int J Cardiol. 2013;167:1724–36.

    Article  PubMed  Google Scholar 

  13. Minamimoto R, Morooka M, Kubota K, Ito K, Masuda-Miyata Y, Mitsumoto T, et al. Value of FDG-PET/CT using unfractionated heparin for managing primary cardiac lymphoma and several key findings. J Nucl Cardiol. 2011;18:516–20.

    Article  PubMed  Google Scholar 

  14. Langah R, Spicer K, Gebregziabher M, Gardon L. Effectiveness of prolonged fasting 18F-FDG PET/CT in the detection of cardiac sarcoidosis. J Nucl Cardiol. 2009;16:801–10.

    Article  PubMed  Google Scholar 

  15. Lum DP, Wandell S, Ko J, Coel MN. Reduction of myocardial-2-deoxy-2-(18F)fuoro-D-glucose uptake artifacts in positron emission tomography using dietary carbohydrate restriction. Mol Imaging Biol. 2002;4:332–7.

    Article  Google Scholar 

  16. Kouijzer JE, Vos J, Janssen JR, van Dijk PJ, Oyen WJ, Bleeker-Rovers CP. The value of 18F-FDG PET/CT in diagnosing infectious endocarditis. Eur J Nucl Med Mol Imaging. 2013;40:1102–7.

    Article  CAS  PubMed  Google Scholar 

  17. Ricciardi A, Sordillo P, Ceccarelli L, Maffongelli G, Calistri G, Di Pietro B, et al. 18-Fluoro-2-deoxyglucose positron emission tomography-computed tomography: an additional tool in the diagnosis of prosthetic valve endocarditis. Int J Infect Dis. 2014;28:219–24.

    Article  PubMed  Google Scholar 

  18. Sarrazin JF, Philippon F, Tessier M, Guimond J, Molin F, Champagne J, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. J Am Coll Cardiol. 2012;59:1616–25.

    Article  PubMed  Google Scholar 

  19. Cautela J, Alessandrini S, Cammilleri S, Giorgi R, Richet H, Casalta JP, et al. Diagnostic yield of FDG positron-emission tomography/computed tomography in patients with CEID infection: a pilot study. Europace. 2013;15:252–7.

    Article  PubMed  Google Scholar 

  20. Graziosi M, Nanni C, Lorenzini M, Diemberger I, Bonfiglioli R, Pasquale F, et al. Role of 18F-FDG PET/CT in the diagnosis of infective endocarditis in patients with an implanted cardiac device: a prospective study. Eur J Nucl Med Mol Imaging. 2014;41:1617–23.

  21. Kamel EM, Burger C, Burk A, Von Schulthess GK, Goerres GW. Impact of metallic dental implants on CT-based attenuation correction in a combined PET/CT scanner. Eur Radiol. 2003;13:724–8.

    Article  PubMed  Google Scholar 

  22. Goerres GW, Ziegler SI, Burger C, Berthold T, Von Schulthess GK, Buck A. Artefacts at PET and PET/CT caused by metallic hip prosthetic material. Radiology. 2003;226:577–84.

    Article  PubMed  Google Scholar 

  23. Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on Interim-PET-Scan in Lymphoma. 2009;50:1257–60.

  24. Pilkington Woll JP, García Vicente AM, Talavera Rubio MP, Palomar Muñoz AM, Jiménez Londoño G, León Martín A, et al. Evaluación cuantitativa y cualitativa de la PET/TC a mitad del tratamiento en linfomas en la predicción de respuesta metabólica completa. Rev Esp Med Nucl Imagen Mol. 2013;32:70–6.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Clínico San Carlos University Hospital, San Carlos Health Research Institute (IdISSC), Complutense University of Madrid, C/Prof. Martín Lagos s/n, 28040, Madrid, Spain

    Ana Jiménez-Ballvé, María Jesús Pérez-Castejón, Roberto C. Delgado-Bolton & José L. Carreras-Delgado

  2. Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, C/Piqueras 98, Logroño, 26006, La Rioja, Spain

    Roberto C. Delgado-Bolton

  3. Department of Cardiology, Clínico San Carlos University Hospital, C/Prof. Martín Lagos s/n, 28040, Madrid, Spain

    Cristina Sánchez-Enrique, Isidre Vilacosta, David Vivas & Carmen Olmos

  4. Research Unit, Clínico San Carlos University Hospital, C/Prof. Martín Lagos s/n, 28040, Madrid, Spain

    Manuel E. Fuentes Ferrer

Authors
  1. Ana Jiménez-Ballvé
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  2. María Jesús Pérez-Castejón
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  3. Roberto C. Delgado-Bolton
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  4. Cristina Sánchez-Enrique
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  6. David Vivas
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  8. Manuel E. Fuentes Ferrer
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  9. José L. Carreras-Delgado
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Correspondence to Ana Jiménez-Ballvé or Roberto C. Delgado-Bolton.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Jiménez-Ballvé, A., Pérez-Castejón, M.J., Delgado-Bolton, R.C. et al. Assessment of the diagnostic accuracy of 18F-FDG PET/CT in prosthetic infective endocarditis and cardiac implantable electronic device infection: comparison of different interpretation criteria. Eur J Nucl Med Mol Imaging 43, 2401–2412 (2016). https://doi.org/10.1007/s00259-016-3463-9

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  • DOI: https://doi.org/10.1007/s00259-016-3463-9

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