Cardiology department, La Timone Hospital, AP-HM, 13005 Marseille, France.
Department of nuclear medicine, La Timone Hospital, AP-HM, 13005 Marseille, France.
Arch Cardiovasc Dis. 2021 Mar;114(3):211-220. doi: 10.1016/j.acvd.2020.10.005. Epub 2021 Jan 22.
F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-FDG PET/CT) has recently been added as a major criterion in the European Society of Cardiology (ESC) 2015 infective endocarditis guidelines. PET/CT is currently used in patients with suspected prosthetic valve and cardiac device-related endocarditis. However, the value of the ESC classification and the clinical impact of PET findings are unknown in patients with native valve endocarditis (NVE).
Our aims were: to assess the value of the ESC criteria (including PET/CT) in NVE; to determine the usefulness of PET/CT concerning embolic detection; and to describe a new PET/CT feature (diffuse splenic uptake).
Between 2012 and 2017, 75 patients with suspected NVE were included prospectively, after exclusion of patients with uninterpretable or unfeasible PET/CT. Using gold standard expert consensus, 63 cases of infective endocarditis were confirmed and 12 were rejected.
Significant valvular uptake was observed in 11 of 63 patients with definite NVE and in no patients who had the diagnosis of infective endocarditis rejected (sensitivity 17.5%, specificity 100%). Among the 63 patients with NVE, a peripheral embolism or mycotic aneurysm was observed in 20 (31.7%) cases. Application of the ESC criteria increased Duke criteria sensitivity from 63.5% to 69.8% (P<0.001), without a change in specificity. Diffuse splenic uptake was observed in 39 (52.0%) patients, including 37 (58.7%) with a final diagnosis of NVE (specificity 83.3%).
F-FDG PET/CT has poor sensitivity but high specificity in the diagnosis of NVE. The usefulness of F-FDG PET/CT is high for embolic detection. Diffuse splenic uptake represents a possible new diagnostic criterion for NVE.
正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）最近被添加为欧洲心脏病学会（ESC）2015 年感染性心内膜炎指南的主要标准之一。PET/CT 目前用于疑似人工瓣膜和心脏器械相关心内膜炎患者。然而，在原发性瓣膜心内膜炎（NVE）患者中，ESC 分类的价值和 PET 结果的临床影响尚不清楚。
我们的目的是：评估 ESC 标准（包括 PET/CT）在 NVE 中的价值；确定 PET/CT 在栓塞检测方面的有用性；并描述一个新的 PET/CT 特征（脾脏弥漫性摄取）。
2012 年至 2017 年期间，前瞻性纳入 75 例疑似 NVE 患者，排除 PET/CT 结果不可解释或不可行的患者。使用金标准专家共识，63 例感染性心内膜炎被确诊，12 例被排除。
在 63 例确诊的 NVE 患者中，11 例患者的瓣膜有明显摄取，而在被排除的感染性心内膜炎患者中无一例（敏感性 17.5%，特异性 100%）。在 63 例 NVE 患者中，20 例（31.7%）患者出现外周栓塞或真菌性动脉瘤。应用 ESC 标准后，杜克标准的敏感性从 63.5%提高到 69.8%（P<0.001），而特异性无变化。39 例（52.0%）患者出现脾脏弥漫性摄取，其中 37 例（58.7%）最终诊断为 NVE（特异性 83.3%）。
F-FDG PET/CT 对 NVE 的诊断敏感性低，但特异性高。F-FDG PET/CT 对栓塞检测有用。脾脏弥漫性摄取可能是 NVE 的一个新的诊断标准。
