%0 Journal Article
%T 18F-fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of native valve infective endocarditis: A prospective study.
%A Philip M
%A Delcourt S
%A Mancini J
%A Tessonnier L
%A Cammilleri S
%A Arregle F
%A Martel H
%A Oliver L
%A Hubert S
%A Renard S
%A Camoin L
%A Casalta AC
%A Casalta JP
%A Gouriet F
%A Riberi A
%A Lepidi H
%A Collart F
%A Raoult D
%A Drancourt M
%A Habib G
%J Arch Cardiovasc Dis
%V 114
%N 3
%D Mar 2021
%M 33495137
%F 3.196
%R 10.1016/j.acvd.2020.10.005
%X <B>BACKGROUND: </B>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).<BR><B>OBJECTIVE: </B>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).<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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%).<BR><B>CONCLUSIONS: </B>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.