Positron Emission Tomography/Computed Tomography for?Diagnosis of Prosthetic Valve Endocarditis: Increased Valvular ¹⁸F-Fluorodeoxyglucose Uptake as a Novel Major Criterion

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• 作者：Ludivine Saby ; MD^* ; Olivia Laas ; MD^&dagger ; ; Gilbert Habib ; MD^* ; ^{gilbert.habib@free.fr} ; Serge Cammilleri ; MD ; PhD^&dagger ; ; Julien Mancini ; MD ; PhD^&Dagger ; ; Laetitia Tessonnier ; MD^&dagger ; ; Jean-Paul Casalta ; MD^§ ; ; Frederique Gouriet ; MD ; PhD^§ ; ; Alberto Riberi ; MD^? ; Jean-Francois Avierinos ; MD^* ; Frederic Collart ; MD^? ; Olivier Mundler ; MD ; PhD^&dagger ; ; Didier Raoult ; MD ; PhD^§ ; ; Franck Thuny ; MD ; PhD^* ; ^§ ; ; ^¶ ; ; ^{franck.thuny@gmail.com}
• 关键词：cardiac imaging ; diagnosis ; endocarditis ; positron emission tomography ; prosthetic valve
• 刊名：Journal of the American College of Cardiology
• 出版年：2013
• 出版时间：11 June, 2013
• 年：2013
• 卷：61
• 期：23
• 页码：2374-2382
• 全文大小：1507 K

文摘

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Objectives

This study sought to determine the value of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-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 ¹⁸F-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.