Venet Maëlys, Jalal Zakaria, Ly Reaksmei, Malekzadeh-Milani Sophie, Hascoët Sebastien, Fournier Emmanuelle, Ovaert Caroline, Casalta Anne Claire, Karsenty Clément, Baruteau Alban Elouen, Le Gloan Laurianne, Selegny Maëlle, Douchin Stéphanie, Bouvaist Hélène, Belaroussi Yaniss, Camou Fabrice, Tlili Ghoufrane, Thambo Jean-Benoît
Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.
Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.
JACC Cardiovasc Imaging. 2022 Feb;15(2):299-308. doi: 10.1016/j.jcmg.2021.07.015. Epub 2021 Sep 15.
The aim of this study was to assess the diagnostic performances of F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) in congenital heart disease (CHD) patients with pulmonary prosthetic valve or conduit endocarditis (PPVE) suspicion.
PPVE is a major issue in the growing CHD population. Diagnosis is challenging, and usual imaging tools are not always efficient or validated in this specific population. Particularly, the diagnostic yield of F-FDG PET/CT remains poorly studied in PPVE.
A retrospective multicenter study was conducted in 8 French tertiary centers. Children and adult CHD patients who underwent F-FDG PET/CT in the setting of PPVE suspicion between January 2010 and May 2020 were included. The cases were initially classified as definite, possible, or rejected PPVE regarding the modified Duke criteria and finally by the Endocarditis Team consensus. The result of F-FDG PET/CT had been compared with final diagnosis consensus used as gold-standard in our study.
A total of 66 cases of PPVE suspicion involving 59 patients (median age 23 years, 73% men) were included. Sensitivity, specificity, positive predictive value, and negative predictive value of F-FDG PET/CT in PPVE suspicion were respectively: 79.1% (95% CI: 68.4%-91.4%), 72.7% (95% CI: 60.4%-85.0%), 91.9% (95% CI: 79.6%-100.0%), and 47.1% (95% CI: 34.8%-59.4%). F-FDG PET/CT findings would help to correctly reclassify 57% (4 of 7) of possible PPVE to definite PPVE.
Using F-FDG PET/CT improves the diagnostic accuracy of the Duke criteria in CHD patients with suspected PPVE. Its high positive predictive value could be helpful in routine to shorten diagnosis and treatment delays and improve clinical outcomes.
本研究旨在评估氟脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）对疑似患有肺动脉人工瓣膜或管道心内膜炎（PPVE）的先天性心脏病（CHD）患者的诊断效能。
PPVE是不断增加的CHD患者群体中的一个主要问题。诊断具有挑战性，常规成像工具在这一特定人群中并不总是有效或经过验证的。特别是，F-FDG PET/CT在PPVE中的诊断价值仍研究不足。
在法国8家三级中心进行了一项回顾性多中心研究。纳入了2010年1月至2020年5月期间因疑似PPVE而接受F-FDG PET/CT检查的儿童和成人CHD患者。根据改良的杜克标准，病例最初被分类为确诊、可能或排除PPVE，最终由心内膜炎团队达成共识。F-FDG PET/CT的结果与我们研究中用作金标准的最终诊断共识进行了比较。
共纳入66例疑似PPVE病例，涉及59名患者（中位年龄23岁，73%为男性）。F-FDG PET/CT对疑似PPVE的敏感性、特异性、阳性预测值和阴性预测值分别为：79.1%（95%CI：68.4%-91.4%）、72.7%（95%CI：60.4%-85.0%）、91.9%（95%CI：79.6%-100.0%）和47.1%（95%CI：34.8%-59.4%）。F-FDG PET/CT检查结果有助于将57%（7例中的4例）可能的PPVE正确重新分类为确诊PPVE。
使用F-FDG PET/CT可提高疑似PPVE的CHD患者中杜克标准的诊断准确性。其高阳性预测值有助于在常规诊断中缩短诊断和治疗延迟并改善临床结局。
