Abstract
Purpose
Early detection of infectious endocarditis is challenging. For diagnosing infectious endocarditis, the revised Duke criteria are the gold standard. Evidence of endocardial involvement on echocardiography is a major criterion, but sensitivity and specificity of echocardiography are not optimal. Here we investigated the utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) to diagnose infectious endocarditis in patients with gram-positive bacteraemia.
Methods
Seventy-two patients with gram-positive bacteraemia were prospectively included. Patients with a positive blood culture growing Staphylococcus aureus, Streptococcus species or Enterococcus species were eligible when a risk factor for developing metastatic infectious foci was present. Infectious endocarditis was defined according to the revised Duke criteria. All patients underwent 18F-FDG PET/CT and echocardiography. 18F-FDG uptake in or around the heart valves was evaluated independently by two nuclear medicine physicians.
Results
Sensitivity for diagnosing infectious endocarditis with 18F-FDG PET/CT was 39 % and specificity was 93 %. The positive predictive value was 64 % and negative predictive value was 82 %. The mortality rate in patients without infectious endocarditis and without increased 18F-FDG uptake in or around the heart valves was 18 %, and in patients without infectious endocarditis but with high 18F-FDG uptake in or around the heart valves the mortality rate was 50 % (p = 0.181).
Conclusion
18F-FDG PET/CT is currently not sufficiently adequate for the diagnosis of infectious endocarditis because of its low sensitivity. Improvements such as patient preparation with low carbohydrate–fat allowed diet and technical advances in the newest PET/CT scanners may increase sensitivity in future studies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rieg S, Peyerl-Hoffmann G, de With K, Theilacker C, Wagner D, Hübner J, et al. Mortality of S. aureus bacteremia and infectious diseases specialist consultation—a study of 521 patients in Germany. J Infect 2009;59:232–9.
Vos FJ, Bleeker-Rovers CP, Sturm PD, Krabbe PF, van Dijk AP, Oyen WJ, et al. Endocarditis: effects of routine echocardiography during Gram-positive bacteraemia. Neth J Med 2011;69:335–40.
Li JS, Sexton DJ, Mick N, Nettles R, Fowler Jr VG, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633–8.
Baddour LM, Wilson WR, Bayer AS, Fowler Jr VG, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, America Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 2005;111:e394–434.
Vos FJ, Bleeker-Rovers CP, Sturm PD, Krabbe PF, van Dijk AP, Cuijpers ML, et al. 18F-FDG PET/CT for detection of metastatic infection in gram-positive bacteremia. J Nucl Med 2010;51:1234–40.
Vos FJ, Bleeker-Rovers CP, Corstens FH, Kullberg BJ, Oyen WJ, et al. FDG-PET for imaging on non-osseous infection and inflammation. Q J Nucl Med Mol Imaging 2006;50:121–30.
Riet J, Hill EE, Gheysens O, Dymarkowski S, Herregods MC, Herijgers P, et al. (18)F-FDG PET/CT for early detection of embolism and metastatic infection in patients with infective endocarditis. Eur J Nucl Med Mol Imaging 2010;37:1189–97.
Yen RF, Chen YC, Wu YW, Pan MH, Chang SC. Using 18-fluoro-2-deoxyglucose positron emission tomography in detecting infectious endocarditis/endoarteritis: a preliminary report. Acad Radiol 2004;11:316–21.
Vind SH, Hess S. Possible role of PET/CT in infective endocarditis. J Nucl Cardiol 2010;17:516–9.
Moghadam-Kia S, Nawaz A, Millar BC, Moore JE, Wiegers SE, Torigian TA, et al. Imaging with (18)F-FDG-PET in infective endocarditis: promising role in difficult diagnosis and treatment monitoring. Hell J Nucl Med 2009;12:165–7.
Vos FJ, Bleeker-Rovers CP, Kullberg BJ, Adang EMM, Oyen WJ. Cost-effectiveness of routine (18)F-FDG PET/CT in high-risk patients with gram-positive bacteremia. J Nucl Med 2011;52:1673–8.
Erba PA, Conti U, Lazzeri E, Sollini M, Doria R, De Tommasi SM, et al. Added value of 99mTc-HMPAO-labeled leukocyte SPECT/CT in the characterization and management of patients with infectious endocarditis. J Nucl Med 2012;53:1235–43.
Balink H, Hut E, Pol T, Flokstra FJ, Roef M. Suppression of 18F-FDG myocardial uptake using a fat-allowed carbohydrate-restricted diet. J Nucl Med Technol 2011;39:185–9.
Coulden R, Chung P, Sonnex E, Ibrahim Q, Maguire C, Abele J. Suppression of myocardial (18)F-FDG uptake with a preparatory “Atkins-style” low-carbohydrate diet. Eur Radiol 2012;22:2221–8.
Le Meunier L, Slomka PJ, Dey D, Ramesh A, Thomson LE, Hayes SW, et al. Motion frozen (18)F-FDG cardiac PET. J Nucl Cardiol 2011;18:259–66.
Acknowledgments
This study was performed without external financial support.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kouijzer, I.J.E., Vos, F.J., Janssen, M.J.R. et al. The value of 18F-FDG PET/CT in diagnosing infectious endocarditis. Eur J Nucl Med Mol Imaging 40, 1102–1107 (2013). https://doi.org/10.1007/s00259-013-2376-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-013-2376-0