18F-fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of native valve infective endocarditis: A prospective study

Mary Philip (1) , Sarkis Delcourt (2) , Julien Mancini (3) , Laetitia Tessonnier (2) , Serge Cammilleri (2) , Florent Arregle (1) , Hélène Martel (1) , Leopold Oliver (1) , Sandrine Hubert (1) , Sébastien Renard (1) , Laurence Camoin (4, 5) , Anne Claire Casalta (1) , Jean Paul Casalta (5, 4) , Frédérique Gouriet (4, 5) , Alberto Riberi (1) , Hubert Lepidi (4, 5) , Frederic Collart (1) , Didier Raoult (4, 5) , Michel Drancourt (4, 5) , Gilbert Habib (4, 1, 5)

1 Département de Cardiologie [Hôpital de la Timone - APHM]
2 TIMONE - Hôpital de la Timone [CHU - APHM]
3 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
4 MEPHI - Microbes évolution phylogénie et infections
5 IHU Marseille - Institut Hospitalier Universitaire Méditerranée Infection

Background: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) has recently been added as a major criterion in the European Society of Cardiology (ESC) 2015 infective endocarditis guidelines. PET/CT is currently used in patients with suspected prosthetic valve and cardiac device-related endocarditis. However, the value of the ESC classification and the clinical impact of PET findings are unknown in patients with native valve endocarditis (NVE). Aims: Our aims were: to assess the value of the ESC criteria (including PET/CT) in NVE; to determine the usefulness of PET/CT concerning embolic detection; and to describe a new PET/CT feature (diffuse splenic uptake). Methods: Between 2012 and 2017, 75 patients with suspected NVE were included prospectively, after exclusion of patients with uninterpretable or unfeasible PET/CT. Using gold standard expert consensus, 63 cases of infective endocarditis were confirmed and 12 were rejected. Results: Significant valvular uptake was observed in 11 of 63 patients with definite NVE and in no patients who had the diagnosis of infective endocarditis rejected (sensitivity 17.5%, specificity 100%). Among the 63 patients with NVE, a peripheral embolism or mycotic aneurysm was observed in 20 (31.7%) cases. Application of the ESC criteria increased Duke criteria sensitivity from 63.5% to 69.8% (P<0.001), without a change in specificity. Diffuse splenic uptake was observed in 39 (52.0%) patients, including 37 (58.7%) with a final diagnosis of NVE (specificity 83.3%). Conclusions: 18F-FDG PET/CT has poor sensitivity but high specificity in the diagnosis of NVE. The usefulness of 18F-FDG PET/CT is high for embolic detection. Diffuse splenic uptake represents a possible new diagnostic criterion for NVE.

Mots clés: Endocarditis; Guidelines; Nuclear imaging; Recommandations; Valve disease

Domaines: Bactériologie; Cardiologie et système cardiovasculaire; Maladies émergentes; Maladies infectieuses; Parasitologie; Virologie

Mary Philip, Sarkis Delcourt, Julien Mancini, Laetitia Tessonnier, Serge Cammilleri, et al.. 18F-fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of native valve infective endocarditis: A prospective study. Archives of cardiovascular diseases, 2021, 114 (3), pp.211-220. ⟨10.1016/j.acvd.2020.10.005⟩. ⟨hal-03304396⟩