scholarly journals Infectious endocarditis: Improving diagnostic performance in native and prosthetic valve infection with 18F-FDG PET/CT

2020 ◽  
Author(s):  
Ana Vera Marinho ◽  
José Paulo Almeida ◽  
Paula Soeiro ◽  
Rodolfo Silva ◽  
Francisco Gonçalves ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Diagnostic Performance ◽  
Final Diagnosis ◽  
Prosthetic Material ◽  
Native Valve ◽  
Clinical Challenge ◽  
Duke Criteria ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Background: The diagnosis of infective endocarditis (IE) remains a clinical challenge. Diagnostic accuracy of the modified Duke criteria is suboptimal for native valve endocarditis (NVE) and even worse in the presence of prosthetic material-related infection (PVE). We aim to evaluate the diagnostic performance of 18F-FDG PET in patients with suspected IE referred to perform PET/CT.Methods: Consecutive patients with suspected IE, referred to perform PET/CT between May 2016 and June 2019 were included. Diagnostic performance of modified Duke criteria (mDC) and PET/ CT for IE for NVE and PVE was determined.Results: In total, 82 patients (mean age of 61 ± 19 years, 62% of male gender) were enrolled. There were 67 18F-FDG PET/CT concordant results with final diagnosis, corresponding to a 96% of agreement, k=0.91(p=0.04). A SUV max cutoff value of ≥3.1 identified positive cases with 88.9% sensitivity and 70.0% specificity. In patients with NVE, the addition of PET/CT to the mDC resulted in a reduction of the number of possible IE cases (from 58% to 4.3%). In patients with PVE/intracardiac devices, PET/CT allowed reclassification of 67.4% of possible cases to 4.2%. An alternative diagnosis was provided in 55.6% of the negative IE cases.Conclusions: 18F-FDG PET/CT proved to be a useful diagnostic tool in patients with both suspected NVE and PVE with good sensitivity and specificity, resulting in a significant decrease of the number of possible endocarditis. Furthermore, it allowed the identification of the cause of clinical scenario in more than 50% of patients in which the diagnosis was excluded.

scholarly journals Infectious endocarditis: Improving Diagnostic Performance in Native and Prosthetic Valve Infection with 18F-FDG PET/CT

2020 ◽  
Author(s):  
Ana Vera Marinho ◽  
José Paulo Almeida ◽  
Paula Soeiro ◽  
Rodolfo Silva ◽  
Francisco Gonçalves ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Diagnostic Performance ◽  
Final Diagnosis ◽  
Prosthetic Material ◽  
Native Valve ◽  
Clinical Challenge ◽  
Duke Criteria ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract BackgroundThe diagnosis of infective endocarditis (IE) remains a clinical challenge. Diagnostic accuracy of the modified Duke criteria is suboptimal for native valve endocarditis (NVE) and even worse in the presence of prosthetic material-related infection (PVE). We aim to evaluate the diagnostic performance of 18F-FDG PET in patients with suspected IE referred to perform PET/CT.Methods: Consecutive patients with suspected IE, referred to perform PET/CT between May 2016 and June 2019 were included. Diagnostic performance of modified Duke criteria (mDC) and PET/ CT for IE for NVE and PVE was determined.Results: In total, 82 patients (mean age of 61 ± 19 years, 62% of male gender) were enrolled. There were 67 18F-FDG PET/CT concordant results with final diagnosis, corresponding to a 96% of agreement, k=0.91(p=0.04). A SUVmax cutoff value of ≥3.1 identified positive cases with 88.9% sensitivity and 70.0% specificity. In patients with NVE, the addition of PET/CT to the mDC resulted in a reduction of the number of possible IE cases (from 58% to 4.3%). In patients with PVE/intracardiac devices, PET/CT allowed reclassification of 67.4% of possible cases to 4.2%. An alternative diagnosis was provided in 55.6% of the negative IE cases.Conclusions: 18F-FDG PET/CT proved to be a useful diagnostic tool in patients with both suspected NVE and PVE with good sensitivity and specificity, resulting in a significant decrease of the number of possible endocarditis. Furthermore, it allowed the identification of the cause of clinical scenario in more than 50% of patients in which the diagnosis was excluded.

scholarly journals Infectious endocarditis: Improving diagnostic performance in native and prosthetic valve infection with 18F-FDG PET/CT

2020 ◽  
Author(s):  
Ana Vera Marinho ◽  
José Paulo Almeida ◽  
Paula Soeiro ◽  
Rodolfo Silva ◽  
Francisco Gonçalves ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Diagnostic Performance ◽  
Final Diagnosis ◽  
Prosthetic Material ◽  
Native Valve ◽  
Clinical Challenge ◽  
Duke Criteria ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Background The diagnosis of infective endocarditis (IE) remains a clinical challenge. Diagnostic accuracy of the modified Duke criteria is suboptimal for native valve endocarditis (NVE) and even worse in the presence of prosthetic material-related infection (PVE). We aim to evaluate the diagnostic performance of 18F-FDG PET in patients with suspected IE referred to perform PET/CT.Methods: Consecutive patients with suspected IE, referred to perform PET/CT between May 2016 and June 2019 were included. Diagnostic performance of modified Duke criteria (mDC) and PET/ CT for IE for NVE and PVE was determined.Results: In total, 82 patients (mean age of 61 ± 19 years, 62% of male gender) were enrolled. There were 67 18F-FDG PET/CT concordant results with final diagnosis, corresponding to a 96% of agreement, k=0.91(p=0.04). A SUV max cutoff value of ≥3.1 identified positive cases with 88.9% sensitivity and 70.0% specificity. In patients with NVE, the addition of PET/CT to the mDC resulted in a reduction of the number of possible IE cases (from 58% to 4.3%). In patients with PVE/intracardiac devices, PET/CT allowed reclassification of 67.4% of possible cases to 4.2%. An alternative diagnosis was provided in 55.6% of the negative IE cases.Conclusions:18F-FDG PET/CT proved to be a useful diagnostic tool in patients with both suspected NVE and PVE with good sensitivity and specificity, resulting in a significant decrease of the number of possible endocarditis. Furthermore, it allowed the identification of the cause of clinical scenario in more than 50% of patients in which the diagnosis was excluded.

Infectious endocarditis: improving diagnostic performance in native and prosthetic valve infectious with 18F-FDG PET/CT

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P.L De Almeida ◽  
V Marinho ◽  
R Silva ◽  
F Goncalves ◽  
G Costa ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Diagnostic Performance ◽  
Final Diagnosis ◽  
Prosthetic Material ◽  
Native Valve ◽  
Clinical Challenge ◽  
Duke Criteria ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Background The diagnosis of infective endocarditis (IE) remains a clinical challenge. Diagnostic accuracy of the modified Duke criteria is suboptimal for native valve endocarditis (NVE) and even worse in the presence of prosthetic material-related infection (PVE). We aim to evaluate the diagnostic performance of 18F-FDG PET in patients with suspected IE referred to perform PET/CT. Methods Consecutive patients with suspected IE, referred to perform PET/CT between May 2016 and June 2019 were included. Diagnostic performance of modified Duke criteria (mDC) and PET/ CT for IE for NVE and PVE was determined. Results In total, 82 patients (mean age of 61±19 years, 62% of male gender) were enrolled. There were 67 18F-FDG PET/CT concordant results with final diagnosis, corresponding to a 96% of agreement, k=0.91 (p=0.04). A SUVmax cutoff value of ≥3.1 identified positive cases with 88.9% sensitivity and 70.0% specificity. In patients with NVE, the addition of PET/CT to the mDC resulted in a reduction of the number of possible IE cases (from 58% to 4.3%). In patients with PVE/intracardiac devices, PET/CT allowed reclassification of 67.4% of possible cases to 4.2%. An alternative diagnosis was provided in 55.6% of the negative IE cases. Conclusions 18F-FDG PET/CT proved to be a useful diagnostic tool in patients with both suspected NVE and PVE with good sensitivity and specificity, resulting in a significant decrease of the number of possible endocarditis. Furthermore, it allowed the identification of the cause of clinical scenario in more than 50% of patients in which the diagnosis was excluded. 18F-FDG PET SUV max ROC for IE diagnosis Funding Acknowledgement Type of funding source: None

Qualitative and semiquantitative [18F]FDG-PET/CT analysis in patients with IE: a strategy to enhance specificity?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Boni
Keyword(s):  
Fdg Pet ◽  
Final Diagnosis ◽  
Antimicrobial Treatment ◽  
Uptake Ratio ◽  
Fdg Uptake ◽  
Duke Criteria ◽  
Focal Uptake ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Aim The 2015 ESC Guideline for the diagnosis and management of infectious endocarditis (IE) included molecular imaging procedures such as radiolabeled leukocytes and [18F]FDG-PET/CT as major criteria to establish the diagnosis of IE. Whereas in case of radiolabeled leukocytes the criteria for defining positive and negative scan are well established, in case of [18F]FDG-PET/CT a consensus of the criteria that define a positive scan is still lacking. Materials and methods In this work we prospectively evaluated a series of 90 patients (M:F=60:30, mean age 67±16 years, median age 72 years, range 18–88) that performed [18F]FDG-PET/CT for suspected IE between January 2016 and January 2019 in our center to define which pattern of uptake and semiquantitative parameters (SUVmax, SUVmean, valve/liver, valve/lung and valve/mediastinum uptake ratio) present the highest diagnostic accuracy for IE. PET/CT results were correlated with transthoracic (TTE) or transesophageal (TEE) echocardiography, blood culture, the Duke criteria. The new ESC criteria were also evaluated. Results Globally PET/CT presented sensitivity=96% and specificity=75%, NPV= 97% and PPV=68%. A focal pattern of uptake was found 17/30 patients with confirmed IE (mean SUVmax=5.29±1.8, median SUVmax=5.5) whereas whereas a diffuse pattern of uptake was found in 11 patients with confirmed IE (mean SUVmax=8.1±3.5, median SUVmax=7.6). No significant differences between the valve/liver ratio uptake and the valve/mediastinum uptake ratio were found between positive and negative patients with either focal or diffuse pattern of uptake. Interesting, in presence of diffuse valve uptake both SUVmax and the valve/lung uptake ratio were significantly higher in patients with a final diagnosis of IE, including the group of patients under antimicrobial treatment (>90%). PET/CT confirmed its ability to identify extracardiac sites of [18F]FDG uptake in presence of septic embolism (35%) and in patients with other diseases (vasculitis, vascular prosthesis infections, mediastinitis and cancer, particularly in patients with IE sustained by Streptococcus Gallolyticus). Conclusions Our results suggest pattern of [18F]FDG uptake more specific for valve infection is a focal uptake or a diffuse uptake with a SUVmax>5 and a valve/lung ratio >8. Funding Acknowledgement Type of funding source: None

Meta-Analysis of the Diagnostic Performance of 18F-FDG-PET/CT Imaging in Native Valve Endocarditis

2020 ◽  
Author(s):  
Domenico Albano ◽  
Francesco Dondi ◽  
Maria Gazzilli ◽  
Raffaele Giubbini ◽  
Francesco Bertagna
Keyword(s):  
Fdg Pet ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Ct Imaging ◽  
Native Valve ◽  
Native Valve Endocarditis ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

scholarly journals 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-PET/CT) for the diagnosis of native valve infective endocarditis (NVIE): a prospective study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Philip ◽  
S Delcourt ◽  
S Cammilleri ◽  
F Gourriet ◽  
L Tessonnier ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Fdg Pet ◽  
Final Diagnosis ◽  
Native Valve ◽  
Positron Emission ◽  
Pet Ct ◽  
Splenic Uptake ◽  
Major Criterion ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Background and objectives 18F-FDG PET/CT has recently been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines. We and others have demonstrated that18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) / computed tomography (CT) was useful in patients with suspected prosthetic valve and cardiac device IE. However, the sensitivity and specificity of ESC classification is unknown in patients with native valve endocarditis (NVE) as well as the clinical impact of PET findings. Purposes 1. Primary objective: To assess the value of the new ESC criteria including 18F-FDG PET/CT in native valve infective endocarditis (NVIE). 2. Secondary objectives: – to determine the usefulness of PET/CT concerning embolic or neoplastic detection. – to describe a new PET/CT feature, i.e. the diffuse splenic uptake. Methods Between 2012 and 2017, 75 patients with suspected NVIE were prospectively included, after exclusion of patients with uninterpretable or not feasible PET/CT. Using the expert consensus of the Endocarditis Team after a 3-month follow-up as gold standard, 63 IE were confirmed and 12 were rejected. Patients follow-up was scheduled at one and three months after hospitalization. Results Significant cardiac uptake by PET/CT (major criterion) was observed in 11 among 63 patients with definite NVIE and no patients with rejected IE (sensitivity 18%, specificity 100%). Among the 63 patients with a final diagnosis of NVE, a peripheral embolism or mycotic aneurysm was observed in 20 cases (32%). Considering this, the ESC 2015 classification increased the sensitivity of Duke criteria from 64 to 70% (p<0.001) without no change on specificity (p<0.001). Twenty-four patients (38%) were diagnosed with secondary infectious sites or infectious portal of entry. A diffuse splenic uptake was observed in 39 (52%) patients, including 37 (59%) of patients with a final diagnosis of NVE (specificity 83%). Conclusion 1. The value of 18F-FDG PET/CT in NVE diagnosis is poor (18% sensitivity) 2. Usefulness of PET/CT remains high when concerning embolic or neoplastic detection. 3. Our study describes for the first time in NVE a new potential endocarditis criterion, i.e. the presence of a diffuse splenic uptake on 18F-FDG PET/CT Diffuse splenic uptake Funding Acknowledgement Type of funding source: None

Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI

2014 ◽  
Vol 53 (03) ◽  
pp. 89-94 ◽  
Author(s):  
D. H. Lee ◽  
J.-K Yoon ◽  
S. J. Lee ◽  
T. H. Kim ◽  
D. K. Kang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Fdg Pet ◽  
Axillary Lymph Node ◽  
Diagnostic Performance ◽  
Axillary Lymph ◽  
Diagnostic Ability ◽  
Node Metastasis ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

SummaryThe aim of this study was to evaluate the diagnostic abilities of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) compared with those of ultrasonography and magnetic resonance imaging (MRI) for axillary lymph node staging in breast cancer patients. Patients, methods: Pre- operative 18F-FDG PET/non-contrast CT, ultrasonography and MRI were performed in 215 women with breast cancer. Axillary lymph node dissection was performed in all patients and the diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. ROC curves were compared to evaluate the diagnostic ability of several imaging modalities (i. e., ultrasonography, MRI and 18F-FDG PET/CT). Results: In total, 132 patients (61.4%) had axillary lymph node metastasis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of axillary lymph node metastasis were 72.3%, 77.3%, 66.7%, 81.6%, 75.3% for ultrasonography, 67.5%, 78.0%, 65.9%, 79.2%, 74.0% for MRI, and 62.7%, 88.6%, 77.6%, 79.1%, 78.6% for 18F-FDG PET/CT, respectively. There was no significant difference in diagnostic ability among the imaging modalities (i.e., ultrasonography, MRI and 18F-FDG PET/CT). The diagnostic ability of 18F-FDG PET/CT was significantly improved by combination with MRI (p = 0.0002) or ultrasonography (p < 0.0001). The combination of 18F-FDG PET/CT with ultrasonography had a similar diagnostic ability to that of all three modalities combined (18F-FDG PET/CT+ultraso- nography+MRI, p = 0.05). Conclusion: The diagnostic performance of 18F-FDG PET/CT for detection of axillary node metastasis was not significantly different from that of ultrasonography or MRI in breast cancer patients. Combining 18F-FDG PET/CT with ultrasonography or MRI could improve the diagnostic performance compared to 18F-FDG PET/CT alone.

scholarly journals Advantages of 18F-FDG PET/CT Imaging over Modified Duke Criteria and Clinical Presumption in Patients with Challenging Suspicion of Infective Endocarditis

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 720
Author(s):  
Valentin Pretet ◽  
Cyrille Blondet ◽  
Yvon Ruch ◽  
Matias Martinez ◽  
Soraya El Ghannudi ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Predictive Value ◽  
Fdg Pet ◽  
Clinical Suspicion ◽  
Duke Criteria ◽  
High Clinical Suspicion ◽  
Pet Ct ◽  
18F Fdg ◽  
Sensitivity Specificity ◽  
Fdg Pet Ct

According to European Society of Cardiology guidelines (ESC2015) for infective endocarditis (IE) management, modified Duke criteria (mDC) are implemented with a degree of clinical suspicion degree, leading to grades such as “possible” or “rejected” IE despite a persisting high level of clinical suspicion. Herein, we evaluate the 18F-FDG PET/CT diagnostic and therapeutic impact in IE suspicion, with emphasis on possible/rejected IE with a high clinical suspicion. Excluding cases of definite IE diagnosis, 53 patients who underwent 18F-FDG PET/CT for IE suspicion were selected and afterwards classified according to both mDC (possible IE/Duke 1, rejected IE/Duke 0) and clinical suspicion degree (high and low IE suspicion). The final status regarding IE diagnosis (gold standard) was based on the multidisciplinary decision of the Endocarditis Team, including the ‘imaging specialist’. PET/CT images of the cardiac area were qualitatively interpreted and the intensity of each focus of extra-physiologic 18F-FDG uptake was evaluated by a maximum standardized uptake value (SUVmax) measurement. Extra-cardiac 18F-FDG PET/CT pathological findings were considered to be a possible embolic event, a possible source of IE, or even a concomitant infection. Based on the Endocarditis Team consensus, final diagnosis of IE was retained in 19 (36%) patients and excluded in 34 (64%). With a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and global accuracy of 79%, 100%, 100%, 89%, and 92%, respectively, PET/CT performed significantly better than mDC (p = 0.003), clinical suspicion degree (p = 0.001), and a combination of both (p = 0.001) for IE diagnosis. In 41 patients with possible/rejected IE but high clinical suspicion, sensitivity, specificity, PPV, NPV, and global accuracies were 78%, 100%, 100%, 85%, and 90%, respectively. Moreover, PET/CT contributed to patient management in 24 out of 53 (45%) cases. 18F-FDG PET/CT represents a valuable diagnostic tool that could be proposed for challenging IE cases with significant differences between mDC and clinical suspicion degree. 18F-FDG PET/CT allows a binary diagnosis (definite or rejected IE) by removing uncertain diagnostic situations, thus improving patient therapeutic management.

scholarly journals Comparison of the diagnostic performance and impact on management of 18F-FDG PET/CT and whole-body MRI in multiple myeloma

2021 ◽  
Author(s):  
Olwen Westerland ◽  
◽  
Ashik Amlani ◽  
Christian Kelly-Morland ◽  
Michal Fraczek ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Data ◽  
Bone Disease ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Whole Body ◽  
Bone Lesions ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Purpose Comparative data on the impact of imaging on management is lacking for multiple myeloma. This study compared the diagnostic performance and impact on management of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and whole-body magnetic resonance imaging (WBMRI) in treatment-naive myeloma. Methods Forty-six patients undergoing 18F-FDG PET/CT and WBMRI were reviewed by a nuclear medicine physician and radiologist, respectively, for the presence of myeloma bone disease. Blinded clinical and imaging data were reviewed by two haematologists in consensus and management recorded following clinical data ± 18F-FDG PET/CT or WBMRI. Bone disease was defined using International Myeloma Working Group (IMWG) criteria and a clinical reference standard. Per-patient sensitivity for lesion detection was established. McNemar test compared management based on clinical assessment ± 18F-FDG PET/CT or WBMRI. Results Sensitivity for bone lesions was 69.6% (32/46) for 18F-FDG PET/CT (54.3% (25/46) for PET component alone) and 91.3% (42/46) for WBMRI. 27/46 (58.7%) of cases were concordant. In 19/46 patients (41.3%) WBMRI detected more focal bone lesions than 18F-FDG PET/CT. Based on clinical data alone, 32/46 (69.6%) patients would have been treated. Addition of 18F-FDG PET/CT to clinical data increased this to 40/46 (87.0%) patients (p = 0.02); and WBMRI to clinical data to 43/46 (93.5%) patients (p = 0.002). The difference in treatment decisions was not statistically significant between 18F-FDG PET/CT and WBMRI (p = 0.08). Conclusion Compared to 18F-FDG PET/CT, WBMRI had a higher per patient sensitivity for bone disease. However, treatment decisions were not statistically different and either modality would be appropriate in initial staging, depending on local availability and expertise.

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