title: Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings.
abstract: OBJECTIVE
  The aim of this study was to assess the value of multislice computed tomography (CT) for the assessment of valvular abnormalities in patients with infective endocarditis (IE) in comparison with transesophageal echocardiography (TEE) and intraoperative findings.
  
  
  BACKGROUND
  Multislice CT has recently shown promising data regarding valvular imaging in a 4-dimensional fashion.
  
  
  METHODS
  Thirty-seven consecutive patients with clinically suspected IE were examined with TEE and 64-slice CT or dual-source CT. Twenty-nine patients had definite IE and underwent surgery.
  
  
  RESULTS
  The diagnostic performance of CT for the detection of evident valvular abnormalities for IE compared with TEE was: sensitivity 97%, specificity 88%, positive predictive value (PPV) 97%, and negative predictive value (NPV) 88% on a per-patient basis (n = 37; excellent intermodality agreement kappa = 0.84). CT correctly identified 26 of 27 (96%) patients with valvular vegetations and 9 of 9 (100%) patients with abscesses/pseudoaneurysms compared with the intraoperative specimen. On a per-valve-based analysis, diagnostic accuracy for the detection of vegetations and abscesses/pseudoaneurysms compared with surgery was: sensitivity 96%, specificity 97%, PPV 96%, NPV 97%, and sensitivity 100%, specificity 100%, PPV 100%, NPV 100%, respectively, without significant differences as compared with TEE. Vegetation size measurements by CT correlated (r = 0.95; p <0.001) with TEE (mean 7.6 +/- 5.6 mm). The mobility of vegetations was accurately diagnosed in 21 of 22 (96%) patients with CT, but all of 4 leaflet perforations (<or=2 mm) were missed. CT provided more accurate anatomic information regarding perivalvular extent of abscess/pseudoaneurysms than TEE.
  
  
  CONCLUSIONS
  Multislice CT shows good results in detecting valvular abnormalities in IE and could be applied in pre-operative planning and exclusion of coronary artery disease before surgery.
authors.affiliation: Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria. gudrun.feuchtner@i-med.ac.at
authors.forename: Gudrun M
authors.initials: GM
authors.lastname: Feuchtner
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dichtl
authors.forename: Thomas
authors.initials: T
authors.lastname: Schertler
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.forename: Silvana
authors.initials: S
authors.lastname: Mueller
authors.forename: André
authors.initials: A
authors.lastname: Plass
authors.forename: Ludwig
authors.initials: L
authors.lastname: Mueller
authors.forename: Thomas
authors.initials: T
authors.lastname: Bartel
authors.forename: Florian
authors.initials: F
authors.lastname: Wolf
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D014057:Tomography, X-Ray Computed / Q000379:methods*