Abstract
373
Objectives: Evaluate the diagnostic accuracy and usefulness of 18F-FDG PET/CT in patients who were clinically suspected to have infective endocarditis.
Methods: Retrospectively reviewed patients aged 18 years old and older who underwent 18-F FDG PET/CT as part of the evaluation of possible infective endocarditis at our institution from January 1, 2010 to December 31, 2017. Inclusion criteria for our study were adult patients who presented with fever or other systemic symptoms, new valvular insufficiency, valvular vegetations, bloodstream infection, or embolic symptoms concerning for infective endocarditis. The decision to obtain a PET/CT was made by the multidisciplinary team of cardiology, cardiac surgery, and infectious disease at the time if there was equivocal clinical, radiologic, or echocardiographic findings to support a diagnosis of infective endocarditis. PET/CT parameters including standard uptake values (SUVmax, SUVmean, SUVpeak), metabolic tumor volume, and total lesion glycolysis were analyzed.
Results: 69 patients with suspected IE underwent PET/CT during the study period. All patients underwent a transthoracic or transesophageal echocardiogram (TEE). Of those who underwent a TEE (65%), 69% of patients demonstrated findings that were concerning for possible IE. The sensitivity of PET/CT for diagnosis of IE was 43.8% and specificity was 90.0%. There was 22 patients (31.9%) who demonstrated extra-cardiac sites of infection including vertebral osteomyelitis/diskitis (25%), pulmonary infection (21%), and vascular graft infection (17%).
Conclusions: PET/CT can be a valuable adjunctive diagnostic tool to aid in the diagnosis of equivocal cases of infective endocarditis. Additionally, 31.9% of our patients had extra-cardiac sites of infection that were found on PET/CT.