title: Diagnostic value of imaging in infective endocarditis: a systematic review.
abstract: Sensitivity and specificity of the modified Duke criteria for native valve endocarditis are both suboptimal, at approximately 80%. Diagnostic accuracy for intracardiac prosthetic material-related infection is even lower. Non-invasive imaging modalities could potentially improve diagnosis of infective endocarditis; however, their diagnostic value is unclear. We did a systematic literature review to critically appraise the evidence for the diagnostic performance of these imaging modalities, according to PRISMA and GRADE criteria. We searched PubMed, Embase, and Cochrane databases. 31 studies were included that presented original data on the performance of electrocardiogram (ECG)-gated multidetector CT angiography (MDCTA), ECG-gated MRI,18F-fluorodeoxyglucose (18F-FDG) PET/CT, and leucocyte scintigraphy in diagnosis of native valve endocarditis, intracardiac prosthetic material-related infection, and extracardiac foci in adults. We consistently found positive albeit weak evidence for the diagnostic benefit of18F-FDG PET/CT and MDCTA. We conclude that additional imaging techniques should be considered if infective endocarditis is suspected. We propose an evidence-based diagnostic work-up for infective endocarditis including these non-invasive techniques.
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. Electronic address: a.gomes@umcg.nl.
authors.forename: Anna
authors.initials: A
authors.lastname: Gomes
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Andor W J M
authors.initials: AWJM
authors.lastname: Glaudemans
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Daan J
authors.initials: DJ
authors.lastname: Touw
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.affiliation: Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Tineke P
authors.initials: TP
authors.lastname: Willems
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Maass
authors.affiliation: Department of Thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Natour
authors.affiliation: Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Niek H J
authors.initials: NHJ
authors.lastname: Prakken
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Ronald J H
authors.initials: RJH
authors.lastname: Borra
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: van Geel
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Biomedical Photonic Imaging, University of Twente, Enschede, Netherlands.
authors.forename: Riemer H J A
authors.initials: RHJA
authors.lastname: Slart
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Sander
authors.initials: S
authors.lastname: van Assen
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Bhanu
authors.initials: B
authors.lastname: Sinha
mesh_terms: D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D004696:Endocarditis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000401:mortality; D019788:Fluorodeoxyglucose F18; D006801:Humans; D012680:Sensitivity and Specificity
chemical_list: D019788:Fluorodeoxyglucose F18