title: Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular 18F-fluorodeoxyglucose uptake as a novel major criterion.
abstract: OBJECTIVE
  This study sought to determine the value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) for diagnosing prosthetic valve endocarditis (PVE).
  
  
  BACKGROUND
  The diagnosis of PVE remains challenging. In PVE cases, initial echocardiography is normal or inconclusive in almost 30%, leading to a decreased diagnostic accuracy for the modified Duke criteria.
  
  
  METHODS
  We prospectively studied 72 consecutive patients suspected of having PVE. All of the patients were subjected to clinical, microbiological, and echocardiographic evaluation. Cardiac PET/CT was performed at admission. The final diagnosis was defined according to the clinical and/or pathological modified Duke criteria determined during a 3-month follow-up.
  
  
  RESULTS
  Thirty-six patients (50%) exhibited abnormal FDG uptake around the site of the prosthetic valve. The sensitivity, specificity, positive predictive value, negative predictive value, and global accuracy were as follows (95% confidence interval): 73% (54% to 87%), 80% (56% to 93%), 85% (64% to 95%), 67% (45% to 84%), and 76% (63% to 86%), respectively. Adding abnormal FDG uptake around the prosthetic valve as a new major criterion significantly increased the sensitivity of the modified Duke criteria at admission (70% [52% to 83%] vs. 97% [83% to 99%], p = 0.008). This result was due to a significant reduction (p < 0.0001) in the number of possible PVE cases from 40 (56%) to 23 (32%).
  
  
  CONCLUSIONS
  The use of (18)F-FDG PET/CT was helpful for diagnosing PVE. The results of this study support the addition of abnormal FDG uptake as a novel major criterion for PVE.
authors.affiliation: Département de Cardiologie, Hôpital de la Timone, AP-HM, Aix-Marseille Université, Marseille, France.
authors.forename: Ludivine
authors.initials: L
authors.lastname: Saby
authors.forename: Olivia
authors.initials: O
authors.lastname: Laas
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.forename: Serge
authors.initials: S
authors.lastname: Cammilleri
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Laetitia
authors.initials: L
authors.lastname: Tessonnier
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Casalta
authors.forename: Frederique
authors.initials: F
authors.lastname: Gouriet
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Avierinos
authors.forename: Frederic
authors.initials: F
authors.lastname: Collart
authors.forename: Olivier
authors.initials: O
authors.lastname: Mundler
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000628:therapy; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18