title: Role of (18)F-FDG PET in Patients with Infectious Endocarditis.
abstract: It was our purpose to evaluate the clinical impact of systematic PET/CT for the diagnosis of infectious embolisms in patients with infectious endocarditis (IE) in comparison with a historic cohort of IE patients managed without this technique. Detection of extracardiac lesions is an essential component of the management and outcome of IE. Studies using PET/CT for the evaluation of patients with IE are scarce, lack a control group, evaluate a small number of patients, or consist of case reports.
  
  
  METHODS
  We performed a prospective cohort study (47 patients with definite IE undergoing PET/CT) with matched controls (94 patients with definite IE not undergoing PET/CT) from January 2012 to July 2013 in a tertiary hospital. The results were compared with those of conventional diagnostic techniques and clinical follow-up.
  
  
  RESULTS
  PET/CT revealed at least 1 lesion in 35 patients (74.5%): 18 showed an embolic complication, 8 showed pathologic uptake on the valves or cardiac devices, 1 showed both, 5 had incidental noninfectious findings, and the findings for 3 were considered false-positive. The validity values for the efficacy of PET/CT in the diagnosis of septic lesions were as follows: sensitivity, 100%; specificity, 80%; positive predictive value, 90%; and negative predictive value, 100%. PET/CT was the only initially positive imaging technique in 15 true-positive cases (55.5%). The systematic use of PET/CT was associated with a 2-fold reduction in the number of relapses (9.6% vs. 4.2%, P = 0.25) and enabled significantly more infectious complications to be diagnosed (18% vs. 57.4%, P = 0.0001).
  
  
  CONCLUSIONS
  PET/CT enables the extent of IE to be assessed using a single test. It is fast (<2 h) and comfortable for the patient, gathers whole-body data, and detects significantly more infectious complications.
authors.affiliation: Clinical Microbiology Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Department of Medicine, Complutense University, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain pmunoz@micro.hggm.es kestler.martha@gmail.com.
authors.forename: Martha
authors.initials: M
authors.lastname: Kestler
authors.affiliation: Clinical Microbiology Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Department of Medicine, Complutense University, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES), Recinto Hospital Joan March, Bunyola, Spain pmunoz@micro.hggm.es kestler.martha@gmail.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Clinical Microbiology Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Department of Medicine, Complutense University, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Rodríguez-Créixems
authors.affiliation: Nuclear Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; and.
authors.forename: Amanda
authors.initials: A
authors.lastname: Rotger
authors.affiliation: Nuclear Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; and.
authors.forename: Felisa
authors.initials: F
authors.lastname: Jimenez-Requena
authors.affiliation: Nuclear Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; and.
authors.forename: Amaia
authors.initials: A
authors.lastname: Mari
authors.affiliation: Nuclear Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; and.
authors.forename: Javier
authors.initials: J
authors.lastname: Orcajo
authors.affiliation: Radiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Hernández
authors.affiliation: Nuclear Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; and.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Alonso
authors.affiliation: Clinical Microbiology Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Department of Medicine, Complutense University, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES), Recinto Hospital Joan March, Bunyola, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D004617:Embolism / Q000150:complications; D004696:Endocarditis / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D018805:Sepsis / Q000150:complications*; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; endocarditis; infectious endocarditis diagnosis; septic embolism