Authors: Ana JiménezBallvé María Jesús PérezCastejón Roberto C DelgadoBolton Cristina SánchezEnrique Isidre Vilacosta David Vivas Carmen Olmos Manuel E Fuentes Ferrer José L CarrerasDelgado
Publish Date: 2016/09/05
Volume: 43, Issue: 13, Pages: 2401-2412
Abstract
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 18FFDG PET/CT in these patients and analyse the interpretation criteriaWe included 41 patients suspected of having IE by the Duke criteria who underwent 18FFDG PET/CT The criteria applied for classifying the findings as positive/negative for IE were a visual analysis of only PET images with attenuationcorrection 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 18FFDG 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 followupWe 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 22 p 0001 When FDG uptake was twice that in the liver IE was always confirmed and SUVmax 55 was the optimal threshold for IE diagnosis using ROC curve analysis area under the curve 071The value of 18FFDG 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 imagesAll 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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