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Journal of Nuclear Cardiology

, Volume 24, Issue 1, pp 195–206 | Cite as

18F-FDG positron emission tomography/computed tomography in infective endocarditis

  • Soile Pauliina Salomäki
  • Antti Saraste
  • Jukka Kemppainen
  • Jeroen J. Bax
  • Juhani Knuuti
  • Pirjo Nuutila
  • Marko Seppänen
  • Anne Roivainen
  • Juhani Airaksinen
  • Laura Pirilä
  • Jarmo Oksi
  • Ulla Hohenthal
Original Article

Abstract

Background

The diagnosis of infective endocarditis (IE), especially the diagnosis of prosthetic valve endocarditis (PVE) is challenging since echocardiographic findings are often scarce in the early phase of the disease. We studied the use of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in IE.

Methods

Sixteen patients with suspected PVE and 7 patients with NVE underwent visual evaluation of 18F-FDG-PET/CT. 18F-FDG uptake was measured also semiquantitatively as maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). The modified Duke criteria were used as a reference.

Results

There was strong, focal 18F-FDG uptake in the area of the affected valve in all 6 cases of definite PVE, in 3 of 5 possible PVE cases, and in 2 of 5 rejected cases. In all patients with definite PVE, SUVmax of the affected valve was higher than 4 and TBR higher than 1.8. In contrast to PVE, only 1 of 7 patients with NVE had uptake of 18F-FDG by PET/CT in the valve area. Embolic infectious foci were detected in 58% of the patients with definite IE.

Conclusions

18F-FDG-PET/CT appears to be a sensitive method for the detection of paravalvular infection associated with PVE. Instead, the sensitivity of PET/CT is limited in NVE.

Keywords

Infective endocarditis prosthetic valve endocarditis echocardiography positron emission tomography 18F-fluorodeoxyglucose 

Abbreviations

IE

Infective endocarditis

PVE

Prosthetic valve endocarditis

NVE

Native valve endocarditis

PET/CT

Positron emission tomography/computed tomography

18F-FDG

2[18F]fluoro-2-deoxy-D-glucose

SUVmax

Maximum standardized uptake value

TBR

Target-to-background ratio

TEE

Transesophageal echocardiography

TTE

Transthoracic echocardiography

Notes

Acknowledgement

The study was conducted in the Finnish Centre of Excellence in Cardiovascular and Metabolic Diseases supported by the Academy of Finland, University of Turku, Turku University Hospital, and Åbo Akademi University. The study was supported by the State Research Funds of the Turku University Hospital, and Orion-Farmos Research Foundation.

Disclosure

The authors have no conflicts of interest to report.

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Copyright information

© American Society of Nuclear Cardiology 2015

Authors and Affiliations

  • Soile Pauliina Salomäki
    • 1
  • Antti Saraste
    • 2
    • 3
    • 5
  • Jukka Kemppainen
    • 2
    • 4
  • Jeroen J. Bax
    • 6
  • Juhani Knuuti
    • 2
  • Pirjo Nuutila
    • 1
    • 2
    • 5
  • Marko Seppänen
    • 2
    • 4
  • Anne Roivainen
    • 2
  • Juhani Airaksinen
    • 3
    • 5
  • Laura Pirilä
    • 1
  • Jarmo Oksi
    • 1
    • 5
  • Ulla Hohenthal
    • 1
  1. 1.Division of MedicineUniversity of Turku and Turku University HospitalTurkuFinland
  2. 2.Turku PET CentreUniversity of Turku and Turku University HospitalTurkuFinland
  3. 3.Heart CenterUniversity of Turku and Turku University HospitalTurkuFinland
  4. 4.Department of Physiology and Nuclear MedicineUniversity of Turku and Turku University HospitalTurkuFinland
  5. 5.Faculty of Medicine, Department of Clinical MedicineUniversity of TurkuTurkuFinland
  6. 6.Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands

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