title: Characterization of18F-Fluorodeoxyglucose Uptake Pattern in Noninfected Prosthetic Heart Valves.
abstract: 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been recently acknowledged as a diagnostic tool for prosthetic valve endocarditis, but its specificity is limited by uptake on noninfected valves. The objective of this study was to outline the main features of FDG uptake on PET/CT in patients with noninfected prosthetic heart valve (PHV).
  
  
  
  Our institution's PET/CT database was reviewed to identify patients with PHV, excluding those suspected of infection or who had received antibiotic treatment. PET indication, valve location, and type (biological/mechanical) and time from implantation were collected for each patient. Images with and without attenuation correction were considered for interpretation. The pattern of FDG uptake (absent, homogeneous, or heterogeneous) was recorded. Fifty-four PHVs (51 patients) were identified, including 32 biological valves. Indications for PET were oncology (n=26), suspicion of prosthetic valve endocarditis subsequently excluded (n=17), and history of vasculitis (n=11). A periprosthetic FDG uptake was present in 47 (87%) and 30 (56%) PHVs with and without attenuation correction, respectively, and the pattern was homogeneous in all but 4 (7%) and 3 (6%) PHVs, respectively. On quantitative analysis, maximum standardized uptake values was greater in mechanical than in biological valves (4.0 [2.4-8.0] versus 3.3 [2.1-6.1];P=0.01) and in patients with vasculitis than in those referred for other indications. The uptake intensity did not differ before and 3 months after valve replacement.
  
  
  
  Noninfected PHVs frequently display homogeneous FDG uptake, which remains steady over time. Caution is, therefore, needed when interpreting FDG PET/CT in suspected prosthetic valve endocarditis, with specific attention to uptake pattern.
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.).
authors.forename: Cédric
authors.initials: C
authors.lastname: Mathieu
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.).
authors.forename: Nidaa
authors.initials: N
authors.lastname: Mikaïl
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.).
authors.forename: Khadija
authors.initials: K
authors.lastname: Benali
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.).
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.).
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.).
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.).
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jondeau
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.).
authors.forename: Fabien
authors.initials: F
authors.lastname: Hyafil
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.).
authors.forename: Dominique
authors.initials: D
authors.lastname: Le Guludec
authors.affiliation: From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation Center 1425, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), France; IAME Inserm 1137 (X.D.); and Department of Cardiac Surgery; Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (P.N.). francois.rouzet@aphp.fr.
authors.forename: François
authors.initials: F
authors.lastname: Rouzet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006351:Heart Valves / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000493:pharmacokinetics*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014018:Tissue Distribution; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG; PET/CT; infective endocarditis; prosthetic heart valve; vasculitis