Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain.
Department of Nuclear Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain.
Int J Comput Assist Radiol Surg. 2023 Jan;18(1):157-169. doi: 10.1007/s11548-022-02729-6. Epub 2022 Sep 2.
Due to the high morbidity and mortality of infective endocarditis (IE), medical imaging techniques are combined to ensure a correct diagnosis. [F]FDG PET/CT has demonstrated the ability to improve diagnostic accuracy compared with the conventional modified Duke criteria in patients with suspected IE, especially those with prosthetic valve infective endocarditis (PVIE). The aim of this study is to provide an adjunctive diagnostic tool to improve the diagnostic accuracy in cardiovascular infections, specifically PVIE.
A segmentation tool to extract quantitative measures of [F]FDG PET/CT image studies of prosthetic heart valve regions was developed and validated in 20 cases of suspected PVIE, of which 9 were confirmed. For that, Valvular Heterogeneity Index (VHI) and Ring-to-Center Ratio (RCR) were defined.
Results show an overall increase in the metabolic uptake of the prosthetic valve ring in the studies with confirmed PVIE diagnosis (SUV from 1.70 to 3.20; SUV from 0.86 to 1.50). The VHI and RCR showed areas under the curve of 0.727 and 0.808 in the receiver operating characteristics curve analyses, respectively, for PVIE diagnosis. Mann-Whitney U tests showed statistically significant differences between groups for RCR (p = 0.02). Visual analyses and clinical reports were concordant with the extracted quantitative metrics.
The proposed new method and presented software solution (CASSIA) provide the capability to assess quantitatively myocardial metabolism along the prosthetic valve region in routine [F]FDG PET/CT scans for evaluating heart valve infectious processes. VHI and RCR are proposed as new potential adjunctive measures for PVIE diagnosis.
由于感染性心内膜炎（IE）的发病率和死亡率较高，因此结合医学影像学技术以确保正确诊断。[F]FDG PET/CT 已证明能够提高疑似 IE 患者的诊断准确性，与传统改良的 Duke 标准相比，尤其是在人工瓣膜感染性心内膜炎（PVIE）患者中。本研究的目的是提供一种辅助诊断工具，以提高心血管感染，特别是 PVIE 的诊断准确性。
开发并验证了一种用于提取人工心脏瓣膜区域[F]FDG PET/CT 图像研究定量指标的分割工具，该工具应用于 20 例疑似 PVIE 患者，其中 9 例得到证实。为此，定义了瓣环异质性指数（VHI）和环心比（RCR）。
结果显示，在确诊为 PVIE 诊断的研究中，人工瓣膜环的代谢摄取总体增加（SUV 从 1.70 增加至 3.20；SUV 从 0.86 增加至 1.50）。VHI 和 RCR 在 ROC 曲线分析中的曲线下面积分别为 0.727 和 0.808。Mann-Whitney U 检验显示 RCR 组间差异具有统计学意义（p=0.02）。视觉分析和临床报告与提取的定量指标一致。
所提出的新方法和所提出的软件解决方案（CASSIA）提供了在常规[F]FDG PET/CT 扫描中评估心脏瓣膜感染过程时沿人工瓣膜区域进行心肌代谢定量评估的能力。VHI 和 RCR 被提议作为 PVIE 诊断的新的潜在辅助措施。
