Diagnostic value of 18F-FDG PET/CT in infective endocarditis

Vanesa Anton-Vazquez; Antonio Cannata; George Amin-Youssef; Samuel Watson; Amanda Fife; Nicola Mulholland; Margaret Gunning; Alexandros Papachristids; Phil MacCarthy; Max Baghai; Ranjit Deshpande; Habib Khan; Jonathan Byrne; Rafal Dworakowski

doi:10.1007/s00392-021-01975-z

Diagnostic value of ¹⁸F-FDG PET/CT in infective endocarditis

Vanesa Anton-Vazquez^*, Antonio Cannata, George Amin-Youssef, Samuel Watson, Amanda Fife, Nicola Mulholland, Margaret Gunning, Alexandros Papachristids, Phil MacCarthy, Max Baghai, Ranjit Deshpande, Habib Khan, Jonathan Byrne, Rafal Dworakowski

^*Corresponding author for this work

King's College London

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

Abstract

Introduction: 18F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET/CT) is not routinely recommended for the diagnosis of infective endocarditis (IE) due to the lack of clinical impact. Materials and methods: Between January 2016 and January 2020, clinical data from patients with a possible diagnosis of IE were reviewed retrospectively to evaluate the value of ¹⁸F-FDG-PET/CT in the diagnosis of IE. ¹⁸F-FDG PET/CT scan was performed as an additional diagnostic tool in possible IE when echocardiography was inconclusive or in patients with definite IE to identify extracardiac complications. Cases were classified according to modified Duke criteria as rejected, definite or possible. Results: 313 patients with suspected IE were included. 72 (23%) patients underwent 18F-FDG PET/CT. ¹⁸F-FDG PET/CT resulted in a reclassification of Duke criteria in 29/72 (40%) patients, from “possible” to “definite” (n, 10) and to “rejected” (n, 19). Patients who benefited from a Duke criteria reclassification following ¹⁸F-FDG PET/CT were more frequently classified as possible IE at inclusion or had a non-conclusive baseline echocardiography (100% vs 58%; p 0.001) and had more likely a prosthetic metallic valve replacement (59% vs 21%; p 0.001). Abnormal perivalvular uptake was identified in 46 patients (71% prosthetic vs 50% native; p 0.118). ¹⁸F-FDG PET/CT identified extracardiac uptake consistent with septic emboli in 14/72 (19%) patients. In addition, extracardiac uptake indicative of an alternative diagnosis was identified in 5 patients (2% prosthetic vs 17% native; p 0.039). Conclusion: The use of ¹⁸F-FDG-PET/CT has shown to be useful in the diagnosis of IE, particularly in prosthetic IE and may provide additional value in the detection of septic emboli and/or the identification of an alternative diagnosis different from IE. Graphical abstract: [Figure not available: see fulltext.]

Original language	English
Journal	Clinical Research In Cardiology
Early online date	25 Nov 2021
DOIs	https://doi.org/10.1007/s00392-021-01975-z
Publication status	E-pub ahead of print - 25 Nov 2021

Keywords

F-FDG-PET/CT
Infective endocarditis

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10.1007/s00392-021-01975-z

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Anton-Vazquez, V., Cannata, A., Amin-Youssef, G., Watson, S., Fife, A., Mulholland, N., Gunning, M., Papachristids, A., MacCarthy, P., Baghai, M., Deshpande, R., Khan, H., Byrne, J., & Dworakowski, R. (2021). Diagnostic value of ¹⁸F-FDG PET/CT in infective endocarditis. Clinical Research In Cardiology. Advance online publication. https://doi.org/10.1007/s00392-021-01975-z

@article{e162d79f1b4e496790b0c2a7ecb4dc12,

title = "Diagnostic value of 18F-FDG PET/CT in infective endocarditis",

abstract = "Introduction: 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET/CT) is not routinely recommended for the diagnosis of infective endocarditis (IE) due to the lack of clinical impact. Materials and methods: Between January 2016 and January 2020, clinical data from patients with a possible diagnosis of IE were reviewed retrospectively to evaluate the value of 18F-FDG-PET/CT in the diagnosis of IE. 18F-FDG PET/CT scan was performed as an additional diagnostic tool in possible IE when echocardiography was inconclusive or in patients with definite IE to identify extracardiac complications. Cases were classified according to modified Duke criteria as rejected, definite or possible. Results: 313 patients with suspected IE were included. 72 (23%) patients underwent 18F-FDG PET/CT. 18F-FDG PET/CT resulted in a reclassification of Duke criteria in 29/72 (40%) patients, from “possible” to “definite” (n, 10) and to “rejected” (n, 19). Patients who benefited from a Duke criteria reclassification following 18F-FDG PET/CT were more frequently classified as possible IE at inclusion or had a non-conclusive baseline echocardiography (100% vs 58%; p 0.001) and had more likely a prosthetic metallic valve replacement (59% vs 21%; p 0.001). Abnormal perivalvular uptake was identified in 46 patients (71% prosthetic vs 50% native; p 0.118). 18F-FDG PET/CT identified extracardiac uptake consistent with septic emboli in 14/72 (19%) patients. In addition, extracardiac uptake indicative of an alternative diagnosis was identified in 5 patients (2% prosthetic vs 17% native; p 0.039). Conclusion: The use of 18F-FDG-PET/CT has shown to be useful in the diagnosis of IE, particularly in prosthetic IE and may provide additional value in the detection of septic emboli and/or the identification of an alternative diagnosis different from IE. Graphical abstract: [Figure not available: see fulltext.]",

keywords = "F-FDG-PET/CT, Infective endocarditis",

author = "Vanesa Anton-Vazquez and Antonio Cannata and George Amin-Youssef and Samuel Watson and Amanda Fife and Nicola Mulholland and Margaret Gunning and Alexandros Papachristids and Phil MacCarthy and Max Baghai and Ranjit Deshpande and Habib Khan and Jonathan Byrne and Rafal Dworakowski",

note = "Publisher Copyright: {\textcopyright} 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.",

year = "2021",

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day = "25",

doi = "10.1007/s00392-021-01975-z",

language = "English",

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T1 - Diagnostic value of 18F-FDG PET/CT in infective endocarditis

AU - Anton-Vazquez, Vanesa

AU - Cannata, Antonio

AU - Amin-Youssef, George

AU - Watson, Samuel

AU - Fife, Amanda

AU - Mulholland, Nicola

AU - Gunning, Margaret

AU - Papachristids, Alexandros

AU - MacCarthy, Phil

AU - Baghai, Max

AU - Deshpande, Ranjit

AU - Khan, Habib

AU - Byrne, Jonathan

AU - Dworakowski, Rafal

PY - 2021/11/25

Y1 - 2021/11/25

N2 - Introduction: 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET/CT) is not routinely recommended for the diagnosis of infective endocarditis (IE) due to the lack of clinical impact. Materials and methods: Between January 2016 and January 2020, clinical data from patients with a possible diagnosis of IE were reviewed retrospectively to evaluate the value of 18F-FDG-PET/CT in the diagnosis of IE. 18F-FDG PET/CT scan was performed as an additional diagnostic tool in possible IE when echocardiography was inconclusive or in patients with definite IE to identify extracardiac complications. Cases were classified according to modified Duke criteria as rejected, definite or possible. Results: 313 patients with suspected IE were included. 72 (23%) patients underwent 18F-FDG PET/CT. 18F-FDG PET/CT resulted in a reclassification of Duke criteria in 29/72 (40%) patients, from “possible” to “definite” (n, 10) and to “rejected” (n, 19). Patients who benefited from a Duke criteria reclassification following 18F-FDG PET/CT were more frequently classified as possible IE at inclusion or had a non-conclusive baseline echocardiography (100% vs 58%; p 0.001) and had more likely a prosthetic metallic valve replacement (59% vs 21%; p 0.001). Abnormal perivalvular uptake was identified in 46 patients (71% prosthetic vs 50% native; p 0.118). 18F-FDG PET/CT identified extracardiac uptake consistent with septic emboli in 14/72 (19%) patients. In addition, extracardiac uptake indicative of an alternative diagnosis was identified in 5 patients (2% prosthetic vs 17% native; p 0.039). Conclusion: The use of 18F-FDG-PET/CT has shown to be useful in the diagnosis of IE, particularly in prosthetic IE and may provide additional value in the detection of septic emboli and/or the identification of an alternative diagnosis different from IE. Graphical abstract: [Figure not available: see fulltext.]

AB - Introduction: 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET/CT) is not routinely recommended for the diagnosis of infective endocarditis (IE) due to the lack of clinical impact. Materials and methods: Between January 2016 and January 2020, clinical data from patients with a possible diagnosis of IE were reviewed retrospectively to evaluate the value of 18F-FDG-PET/CT in the diagnosis of IE. 18F-FDG PET/CT scan was performed as an additional diagnostic tool in possible IE when echocardiography was inconclusive or in patients with definite IE to identify extracardiac complications. Cases were classified according to modified Duke criteria as rejected, definite or possible. Results: 313 patients with suspected IE were included. 72 (23%) patients underwent 18F-FDG PET/CT. 18F-FDG PET/CT resulted in a reclassification of Duke criteria in 29/72 (40%) patients, from “possible” to “definite” (n, 10) and to “rejected” (n, 19). Patients who benefited from a Duke criteria reclassification following 18F-FDG PET/CT were more frequently classified as possible IE at inclusion or had a non-conclusive baseline echocardiography (100% vs 58%; p 0.001) and had more likely a prosthetic metallic valve replacement (59% vs 21%; p 0.001). Abnormal perivalvular uptake was identified in 46 patients (71% prosthetic vs 50% native; p 0.118). 18F-FDG PET/CT identified extracardiac uptake consistent with septic emboli in 14/72 (19%) patients. In addition, extracardiac uptake indicative of an alternative diagnosis was identified in 5 patients (2% prosthetic vs 17% native; p 0.039). Conclusion: The use of 18F-FDG-PET/CT has shown to be useful in the diagnosis of IE, particularly in prosthetic IE and may provide additional value in the detection of septic emboli and/or the identification of an alternative diagnosis different from IE. Graphical abstract: [Figure not available: see fulltext.]

KW - F-FDG-PET/CT

KW - Infective endocarditis

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U2 - 10.1007/s00392-021-01975-z

DO - 10.1007/s00392-021-01975-z

M3 - Article

AN - SCOPUS:85119829394

SN - 1861-0684

JO - Clinical Research In Cardiology

JF - Clinical Research In Cardiology

ER -

Diagnostic value of ¹⁸F-FDG PET/CT in infective endocarditis

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