Gobbo Magali Y, Meretta Alejandro H, Rosa Daniel, Corneli Mariana, Daquarti Gustavo J, Masoli Osvaldo H, Grymberg Laura, Pérez Baliño Néstor, Nacinovich Francisco, Ronderos Ricardo
Departamento de Imágenes Cardiovasculares, Instituto Cardiovascular de Buenos Aires, Argentina. E-mail:
Departamento de Imágenes Cardiovasculares, Instituto Cardiovascular de Buenos Aires, Argentina.
Medicina (B Aires). 2020;80(1):17-22.
Infective endocarditis (IE) is a serious and potentially lethal condition. The diagnostic capacity of the modified Duke criteria is high for native valves, but it declines in the case of EI of prosthetic valves or EI associated with devices. Echocardiography and microbiological findings are essential for diagnosis but may be insufficient in this group of patients. Our objective was to evaluate the usefulness of positron emission tomography and fusion with computed tomography (PET / CT) in patients with suspected IE, carriers of prosthetic valves or intracardiac devices; 32 patients were studied, who underwent PET / CT with 18F-Fluorine deoxyglucose (18F-FDG). Those with intense focal and/or heterogeneous uptake with a Standard Uptake Value SUV) cut-off point greater than or equal to 3.7 were considered suggestive of infection. The initial diagnoses according to the modified Duke criteria were compared with the final diagnosis established by the Institutional Endocarditis Unit. The addition of PET / CT to these criteria, provided a conclusive diagnosis in 22 of the 32 initial cases reclassifying 11 cases in definitive EI; another 5 cases were negative for that diagnosis. EI continues to be a serious clinical problem. In those cases where the Duke criteria are not sufficient to establish the diagnosis and clinical suspicion persists, PET / CT can be a useful complementary tool to increase the diagnostic sensitivity.
感染性心内膜炎（IE）是一种严重且可能致命的疾病。改良的杜克标准对天然瓣膜感染性心内膜炎的诊断能力较高，但对于人工瓣膜心内膜炎（EI）或与装置相关的心内膜炎，其诊断能力会下降。超声心动图和微生物学检查结果对诊断至关重要，但在这类患者中可能并不充分。我们的目的是评估正电子发射断层扫描与计算机断层扫描融合技术（PET/CT）在疑似感染性心内膜炎、人工瓣膜携带者或心内装置携带者患者中的应用价值；对32例患者进行了研究，这些患者接受了18F-氟脱氧葡萄糖（18F-FDG）PET/CT检查。标准摄取值（SUV）截断点大于或等于3.7的局灶性和/或不均匀性摄取强烈的患者被认为提示感染。将根据改良杜克标准的初始诊断与机构性心内膜炎科室确定的最终诊断进行比较。在这些标准中加入PET/CT，在32例初始病例中的22例中提供了确定性诊断，将11例重新分类为确诊的心内膜炎；另有5例该诊断为阴性。心内膜炎仍然是一个严重的临床问题。在杜克标准不足以确立诊断且临床怀疑仍然存在的情况下，PET/CT可以作为一种有用的辅助工具来提高诊断敏感性。
