Kouijzer Ilse J E, Berrevoets Marvin A H, Aarntzen Erik H J G, de Vries Janneke, van Dijk Arie P J, Oyen Wim J G, de Geus-Oei Lioe-Fee, Bleeker-Rovers Chantal P
Departments of Internal Medicine and Infectious Diseases.
MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands.
Nucl Med Commun. 2018 Aug;39(8):747-752. doi: 10.1097/MNM.0000000000000864.
The aim of the study was to investigate the value of F-fluorodeoxyglucose positron-emission tomography combined with computed tomography (F-FDG-PET/CT) in diagnosing native valve endocarditis (NVE).
All patients with bacteremia and suspicion of NVE between January 2013 and June 2016 were identified from the hospitals' register and retrospectively included if echocardiography and F-FDG-PET/CT were performed within 14 days. F-FDG-PET/CT scans were scored independently by two nuclear medicine physicians. F-FDG-PET/CT was compared with the modified-Duke criteria and a multidisciplinary consensus.
A total of 88 patients were included. In 10 patients with definite NVE according to the modified-Duke criteria, three (30.0%) patients had increased F-FDG uptake in or around the heart valves and seven (70.0%) patients had no increased F-FDG uptake. In patients without definite NVE according to the modified-Duke criteria, 89.7% (70/78) of the patients had no increased F-FDG uptake in or around the heart valves. Of all 20 patients with NVE according to multidisciplinary consensus, nine (45.0%) patients had increased F-FDG uptake in or around the heart valves and 11 (55.0%) patients had a normal F-FDG-PET/CT result.
A negative F-FDG-PET/CT result should not be interpreted as an exclusion of NVE. In patients with possible or rejected NVE according to the modified-Duke criteria, F-FDG-PET/CT could be used in case of sustained suspicion of NVE owing to its high specificity in case of abnormal FDG uptake at the valve region. F-FDG-PET/CT is important for detecting metastatic infection which already warrants the need to perform F-FDG-PET/CT in all patients with suspected NVE.
本研究旨在探讨氟脱氧葡萄糖正电子发射断层扫描联合计算机断层扫描（F-FDG-PET/CT）在诊断自体瓣膜心内膜炎（NVE）中的价值。
从医院登记册中识别出2013年1月至2016年6月期间所有患有菌血症且怀疑患有NVE的患者，若在14天内进行了超声心动图和F-FDG-PET/CT检查，则对其进行回顾性纳入。F-FDG-PET/CT扫描由两名核医学医师独立评分。将F-FDG-PET/CT与改良的杜克标准及多学科共识进行比较。
共纳入88例患者。根据改良的杜克标准，在10例确诊为NVE的患者中，3例（30.0%）患者心脏瓣膜或其周围的F-FDG摄取增加，7例（70.0%）患者F-FDG摄取未增加。根据改良的杜克标准未确诊为NVE的患者中，89.7%（70/78）的患者心脏瓣膜或其周围的F-FDG摄取未增加。根据多学科共识，在所有20例NVE患者中，9例（45.0%）患者心脏瓣膜或其周围的F-FDG摄取增加，11例（55.0%）患者的F-FDG-PET/CT结果正常。
F-FDG-PET/CT结果为阴性不应被解释为排除NVE。对于根据改良的杜克标准可能患有或排除NVE的患者，若因瓣膜区域FDG摄取异常而高度怀疑NVE，F-FDG-PET/CT可用于持续怀疑NVE的情况。F-FDG-PET/CT对于检测转移性感染很重要，这已使得有必要对所有疑似NVE的患者进行F-FDG-PET/CT检查。
