APHM, La Timone Hospital, Cardiology Department, Marseille, France.
Department of Nuclear Medicine, La Timone Hospital, Marseille, France.
JACC Cardiovasc Imaging. 2020 Dec;13(12):2605-2615. doi: 10.1016/j.jcmg.2020.04.011. Epub 2020 Jun 17.
The primary objective was to assess the value of the European Society of Cardiology (ESC) criteria, including F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG-PET/CT) in prosthetic valve infective endocarditis (PVE). Secondary objectives were: 1) to assess the reproducibility of F-FDG-PET/CT; 2) to compare its diagnostic value with that of echocardiography; and 3) to assess the diagnostic value of the presence of a diffuse splenic uptake BACKGROUND: F-FDG PET/CT has been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines, but the benefit of the ESC criteria has not been prospectively compared with the conventional Duke criteria.
Between 2014 and 2017, 175 patients with suspected PVE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable F-FDG PET/CT, 115 patients were evaluated, including 91 definite and 24 rejected IE, as defined by an expert consensus.
Cardiac uptake by F-FDG PET/CT was observed in 67 of 91 patients with definite PVE and 6 with rejected IE (sensitivity 73.6% [95% confidence interval (CI): 63.3% to 82.3%], specificity 75% [95% CI: 53.3% to 90.2%]). The ESC 2015 classification increased the sensitivity of Duke criteria from 57.1% (95% CI: 46.3% to 67.5%) to 83.5% (95% CI: 74.3% to 90.5%) (p < 0.001), but decreased its specificity from 95.8% (95% CI: 78.9% to 99.9%) to 70.8% (95% CI: 48.9% to 87.4%). Intraobserver reproducibility of F-FDG PET/CT was good (kappa = 0.84) but interobserver reproducibility was less satisfactory (kappa = 0.63). A diffuse splenic uptake was observed in 24 (20.3%) patients, including 23 (25.3%) of definite PVE, and only 1 (4.2%) rejected PVE (p = 0.024).
F-FDG PET/CT is a useful diagnostic tool in suspected PVE, and explains the greater sensitivity of ESC criteria than Duke criteria. However, F-FDG PET/CT also presents with important limitations concerning its feasibility, specificity, and reproducibility. Our study describes for the first time a new endocarditis criterion, that is, the presence of a diffuse splenic uptake on F-FDG PET/CT.
本研究旨在评估欧洲心脏病学会（ESC）标准（包括 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG-PET/CT））在人工瓣膜感染性心内膜炎（PVE）中的价值。次要目的为：1）评估 F-FDG-PET/CT 的可重复性；2）比较其与超声心动图的诊断价值；3）评估弥漫性脾脏摄取的诊断价值。
F-FDG PET/CT 已被添加为 ESC 2015 年感染性心内膜炎（IE）指南中的一个主要标准，但 ESC 标准的益处尚未与传统的杜克标准进行前瞻性比较。
2014 年至 2017 年间，3 家法国中心前瞻性纳入了 175 例疑似 PVE 的患者。排除 F-FDG-PET/CT 无法解释的患者后，评估了 115 例患者，包括 91 例明确 PVE 和 24 例排除 IE。IE 是由专家共识定义的。
91 例明确 PVE 患者中有 67 例（63.3%至 82.3%）和 6 例排除 IE 患者（75%[95%CI：53.3%至 90.2%]）的 F-FDG-PET/CT 可见心脏摄取。ESC 2015 分类将杜克标准的敏感性从 57.1%（95%CI：46.3%至 67.5%）提高至 83.5%（95%CI：74.3%至 90.5%）（p<0.001），但特异性从 95.8%（95%CI：78.9%至 99.9%）降低至 70.8%（95%CI：48.9%至 87.4%）。F-FDG-PET/CT 的观察者内可重复性良好（kappa=0.84），但观察者间可重复性较差（kappa=0.63）。24 例（20.3%）患者出现弥漫性脾脏摄取，包括 23 例（25.3%）明确 PVE 和 1 例（4.2%）排除 PVE（p=0.024）。
F-FDG-PET/CT 是疑似 PVE 的有用诊断工具，这解释了 ESC 标准比杜克标准具有更高的敏感性。然而，F-FDG-PET/CT 在可行性、特异性和可重复性方面也存在重要限制。本研究首次描述了一个新的感染性心内膜炎标准，即 F-FDG-PET/CT 上弥漫性脾脏摄取。
