18F-FDG PET/CT in the diagnosis of prosthetic valve endocarditis

  • Erika Fagman
  • Martijn van Essen
  • Johan Fredén Lindqvist
  • Ulrika Snygg-Martin
  • Odd Bech-Hanssen
  • Gunnar Svensson
Original Paper


Recent studies have shown promising results using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the diagnosis of prosthetic valve endocarditis (PVE). However, previous studies did not include negative controls. The aim of this study was to compare 18F-FDG-uptake around prosthetic aortic valves in patients with and without PVE and to determine the diagnostic performance of 18F-FDG PET/CT in the diagnosis of PVE. 18F-FDG PET/CT examinations in patients with a prosthetic aortic valve performed 2008–2014 were retrieved. Eight patients with a final diagnosis of definite PVE were included in the analysis of the diagnostic performance of 18F-FDG PET/CT. Examinations performed on suspicion of malignancy in patients without PVE (n = 19) were used as negative controls. Visual and semi-quantitative analysis was performed. Maximal standardized uptake value (SUVmax) in the valve area was measured and SUVratio was calculated by dividing valve SUVmax by SUVmax in the descending aorta. The sensitivity was 75 %, specificity 84 %, positive likelihood ratio [LR(+)] 4.8 and negative likelihood ratio [LR(−)] 0.3 on visual analysis. Both SUVmax and SUVratio were significantly higher in PVE patients [5.8 (IQR 3.5–6.5) and 2.4 (IQR 1.7–3.0)] compared to non-PVE patients [3.2 (IQR 2.8–3.8) and 1.5 (IQR 1.3–1.6)] (p < 0.001). ROC-curve analysis of SUVratio yielded an area under the curve of 0.90 (95 % CI 0.74–1.0). 18F-FDG-uptake around non-infected aortic prosthetic valves was low. The level of 18F-FDG-uptake in the prosthetic valve area showed a good diagnostic performance in the diagnosis of PVE.


Prosthetic valve endocarditis Prosthetic heart valve 18F-FDG PET/CT Positron emission tomography 


Compliance with ethical standards

Conflict of interest



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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Erika Fagman
    • 1
    • 2
  • Martijn van Essen
    • 3
    • 4
  • Johan Fredén Lindqvist
    • 3
    • 4
  • Ulrika Snygg-Martin
    • 5
    • 6
  • Odd Bech-Hanssen
    • 4
    • 7
  • Gunnar Svensson
    • 4
    • 8
  1. 1.Department of RadiologySahlgrenska University HospitalGothenburgSweden
  2. 2.Department of Radiology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  3. 3.Department of Clinical Physiology, Nuclear MedicineSahlgrenska University HospitalGothenburgSweden
  4. 4.Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  5. 5.Department of Infectious DiseasesSahlgrenska University HospitalGothenburgSweden
  6. 6.Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  7. 7.Department of Clinical PhysiologySahlgrenska University HospitalGothenburgSweden
  8. 8.Department of Cardiothoracic SurgerySahlgrenska University HospitalGothenburgSweden

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