title: Clinical utility of18F-FDG positron emission tomography/computed tomography scan vs.99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis.
abstract: The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether18FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49-0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61-0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.
authors.affiliation: Department of Cardiology, The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark. trineklauridsen@gmail.com.|Cardiac Research Unit 2, Department of Cardiology, Herlev-Gentofte University Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark. trineklauridsen@gmail.com.
authors.forename: Trine K
authors.identifier: http://orcid.org/0000-0001-9394-0752
authors.initials: TK
authors.lastname: Lauridsen
authors.affiliation: Department of Cardiology, The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark.|Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Kasper K
authors.initials: KK
authors.lastname: Iversen
authors.affiliation: Department of Cardiology, The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Ihlemann
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Philip
authors.initials: P
authors.lastname: Hasbak
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Annika
authors.initials: A
authors.lastname: Loft
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Berthelsen
authors.affiliation: Cardiac Research Unit 2, Department of Cardiology, Herlev-Gentofte University Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Dahl
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Danijela
authors.initials: D
authors.lastname: Dejanovic
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark.|Department of Nuclear Medicine and Physiology, Herlev-Gentofte University Hospital, Hellerup, Denmark.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Albrecht-Beste
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jann
authors.initials: J
authors.lastname: Mortensen
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kjær
authors.affiliation: Department of Cardiology, The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Bundgaard
authors.affiliation: Clinical Institute, Aalborg University, Aalborg, Denmark.|Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Niels Eske
authors.initials: NE
authors.lastname: Bruun
mesh_terms: D000368:Aged; D004696:Endocarditis / Q000097:blood / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D006801:Humans; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D015203:Reproducibility of Results; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D019690:Technetium Tc 99m Exametazime / Q000008:administration & dosage*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D019690:Technetium Tc 99m Exametazime
keywords: Infectious foci; Infective endocarditis; PET/CT; Reproducibility; SPECT/CT