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Respective Performance of 18 F-FDG PET and Radiolabeled Leukocyte Scintigraphy for the Diagnosis of Prosthetic Valve Endocarditis
Open accessAbstract
UNLABELLED: Echocardiography plays a key role in the diagnosis of infective endocarditis (IE) but can be inconclusive in patients in whom prosthetic valve endocarditis (PVE) is suspected. The incremental diagnostic value of (18)F-FDG PET and radiolabeled leukocyte scintigraphy in IE patients has already been reported. The aim of this study was to compare the respective performance of (18)F-FDG PET and leukocyte scintigraphy for the diagnosis of PVE in 39 patients. METHODS: (18)F-FDG PET and leukocyte scintigraphy were performed on 39 consecutive patients admitted because of clinically suspected PVE and inconclusive echocardiography results. The results of (18)F-FDG PET and leukocyte scintigraphy were analyzed separately and retrospectively by experienced physicians masked to the results of the other imaging technique and to patient outcome. The final Duke-Li IE classification was made after a 3-mo follow-up. RESULTS: Of the 39 patients, 14 were classified as having definite IE, 4 as having possible IE, and 21 as not having IE. The average interval between (18)F-FDG PET and leukocyte scintigraphy was 7 ± 7 d. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 93%, 71%, 68%, 94%, and 80%, respectively, for (18)F-FDG PET and 64%, 100%, 100%, 81%, and 86%, respectively, for leukocyte scintigraphy. Discrepancies between the results of (18)F-FDG PET and leukocyte scintigraphy occurred in 12 patients (31%). In patients with definite IE, 5 had true-positive (18)F-FDG PET results but false-negative leukocyte scintigraphy results. Of these 5 patients, 3 had nonpyogenic microorganism IE (Coxiella or Candida). Of patients for whom endocarditis had been excluded, 6 had true-negative leukocyte scintigraphy results but false-positive (18)F-FDG PET results. These 6 patients had been imaged in the first 2 mo after the last cardiac surgery. The last patient with a discrepancy between (18)F-FDG PET and leukocyte scintigraphy was classified as having possible endocarditis and had positive (18)F-FDG PET results and negative leukocyte scintigraphy results. CONCLUSION: (18)F-FDG PET offers high sensitivity for the detection of active infection in patients with suspected PVE and inconclusive echocardiography results. Leukocyte scintigraphy offers a higher specificity, however, than (18)F-FDG PET for diagnosis of IE and should be considered in cases of inconclusive (18)F-FDG PET findings or in the first 2 mo after cardiac surgery.
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In cardiovascular imaging, postoperative changes or sterile inflammation can be difficult to differentiate from active infection.
“while postoperative changes or sterile inflammation can be difficult to differentiate from active infection [136,137,138].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [136]
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References 17 · Cited by 230
Research works printed but not linked: 14
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Metadata
- Authors
- Rouzet, F., Chequer, R., Benali, K., Lepage, L., Ghodbane, W., Duval, X., Iung, B., Vahanian, A., Le Guludec, D., & Hyafil, F.
- Affiliations
- Inserm (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Hôpital Bichat-Claude-Bernard (FR)
- ORCID
- Venue
- Journal of Nuclear Medicine
- Publisher
- Society of Nuclear Medicine
- Published
- 2014-11-13
- Volume
- 55
- Issue
- 12
- Pages
- 1980-1985
- ISSN
- 0161-5505 (ISSN-L)
- 2159-662X
- OpenAlex
- W2114357428
- Cited by
- 230
- References
- 17
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 22 · 2023: 19 · 2022: 17 · 2021: 26 · 2020: 28 · 2019: 18 · 2018: 20 · 2017: 31 · 2016: 12 · 2015: 12 · 2014: 1
- FWCI
- 14.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Nuclear Medicine (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- prosthetic valve endocarditis, infective endocarditis, 18F-FDG PET, leukocyte scintigraphy, diagnostic accuracy, imaging modality comparison, Coxiella, Candida, sensitivity and specificity, positive predictive value
- MeSH terms
- Aged, Endocarditis, Bacterial, Female, Granulocytes, Heart Valve Prosthesis, Humans, Leukocytes, Male, Middle Aged, Prosthesis-Related Infections, Radiopharmaceuticals, Fluorodeoxyglucose F18, Positron-Emission Tomography
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