Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/35920
Title: The Role of F-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnosis of Left-sided Endocarditis: Native vs Prosthetic Valves Endocarditis
Authors: CAMARGO, Raphael Abegao deBITENCOURT, Marcio SommerMENEGHETTI, Jose ClaudioJR, Jose SoaresGONCALVES, Luis Fernando TonelloBUCHPIGUEL, Carlos AlbertoPAIXAO, Milena RibeiroFELICIO, Marilia FrancesconiSOEIRO, Alexandre de MatosSTRABELLI, Tania Mara VarejaoMANSUR, Alfredo JoseTARASOUTCHI, FlavioJR, Mucio Tavares de OliveiraCASTELLI, Jussara BianchiGUALANDRO, Danielle MenosiPOCEBON, Lucas ZoboliBLANKSTEIN, RonALAVI, AbassMOORE, John EdmundMILLAR, Beverley CherieSICILIANO, Rinaldo Focaccia
Citation: CLINICAL INFECTIOUS DISEASES, v.70, n.4, p.583-594, 2020
Abstract: Background: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding use of F-18-FDG-PET/CT for the diagnosis of native valve endocarditis (NVE). Methods: Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. F-18-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE)/ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and F-18-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis. Results: Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of F-18-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were 22%, 100%, 100%, and 66%. The inclusion of abnormal F-18-FDG cardiac uptake as a major criterion at admission enabled a recategorization of 76% (47/62) of PVE/AAPI cases initially classified as ""possible"" to ""definite"" IE. In the histopathological analysis, a predominance of polymorphonuclear cell inflammatory infiltrate and a reduced extent of fibrosis were observed in the PVE group only. Conclusions: Use of F-18-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the modified Duke criteria. In patients who present with suspected NVE, the use of F-18-FDG-PET/CT is less accurate and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.
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