Demonstration of infective endocarditis by cardiac CT and transoesophageal echocardiography: comparison with intra-operative findings.
We aimed to compare imaging findings of infective endocarditis between computed tomography (CT) and transoesophageal echocardiography (TEE) using surgical inspection as a reference standard.



Forty-nine patients (aged 54 ± 17 years, 69% men) who underwent pre-operative CT and TEE for infective endocarditis were included. Twelve of these patients had prosthetic valve endocarditis. Imaging findings of infective endocarditis were classified as vegetation, leaflet perforation, abscess/pseudoaneurysm, and paravalvular leakage. Diagnostic performances of CT and TEE were evaluated using surgical inspection as a reference standard. Interobserver agreements for CT findings were obtained using Cohen's κ test. The detection rates of infective endocarditis per patient with CT and TEE were 93.9% (46/49) and 95.9% (47/49), respectively. In per-imaging analysis, the sensitivities of CT and TEE were not significantly different for both native and prosthetic valve infective endocarditis (sensitivity: vegetation, 100% in TEE and 90.9% in CT; leaflet perforation, 87.5% in TEE and 50.0% in CT; abscess/pseudoaneurysm, 40.0% in TEE and 60.0% in CT; paravalvular leakage, 100% in TEE and 50.0% in CT). Interobserver agreements for CT findings were substantial or excellent (0.79-0.88).



Cardiac CT can accurately demonstrate infective endocarditis in pre-operative patients with a similar diagnostic accuracy to TEE. The interobserver agreements for the CT findings of infective endocarditis were excellent.
Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Hyun Jung
HJ
Koo
Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Dong Hyun
DH
Yang
Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Joon-Won
JW
Kang
Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Joo Yeon
JY
Lee
Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Dae-Hee
DH
Kim
Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jong-Min
JM
Song
Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Duk-Hyun
DH
Kang
Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jae-Kwan
JK
Song
Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
Joon Bum
JB
Kim
Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
Sung-Ho
SH
Jung
Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
Suk Jung
SJ
Choo
Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
Cheol Hyun
CH
Chung
Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
Jae-Won
JW
Lee
Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Tae-Hwan
TH
Lim
D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D015588:Observer Variation; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
cardiac surgery; computed tomography; echocardiography; infective endocarditis; valvular heart disease