alexa Positron emission tomography computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular 18F-fluorodeoxyglucose uptake as a novel major criterion.
Clinical Research

Clinical Research

Journal of Clinical Case Reports

Author(s): Saby L, Laas O, Habib G, Cammilleri S, Mancini J,

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Abstract OBJECTIVES: This study sought to determine the value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) for diagnosing prosthetic valve endocarditis (PVE). BACKGROUND: The diagnosis of PVE remains challenging. In PVE cases, initial echocardiography is normal or inconclusive in almost 30\%, leading to a decreased diagnostic accuracy for the modified Duke criteria. METHODS: We prospectively studied 72 consecutive patients suspected of having PVE. All of the patients were subjected to clinical, microbiological, and echocardiographic evaluation. Cardiac PET/CT was performed at admission. The final diagnosis was defined according to the clinical and/or pathological modified Duke criteria determined during a 3-month follow-up. RESULTS: Thirty-six patients (50\%) exhibited abnormal FDG uptake around the site of the prosthetic valve. The sensitivity, specificity, positive predictive value, negative predictive value, and global accuracy were as follows (95\% confidence interval): 73\% (54\% to 87\%), 80\% (56\% to 93\%), 85\% (64\% to 95\%), 67\% (45\% to 84\%), and 76\% (63\% to 86\%), respectively. Adding abnormal FDG uptake around the prosthetic valve as a new major criterion significantly increased the sensitivity of the modified Duke criteria at admission (70\% [52\% to 83\%] vs. 97\% [83\% to 99\%], p = 0.008). This result was due to a significant reduction (p < 0.0001) in the number of possible PVE cases from 40 (56\%) to 23 (32\%). CONCLUSIONS: The use of (18)F-FDG PET/CT was helpful for diagnosing PVE. The results of this study support the addition of abnormal FDG uptake as a novel major criterion for PVE. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. This article was published in J Am Coll Cardiol and referenced in Journal of Clinical Case Reports

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