Tordi Sara, Gonnelli Giacomo, Benvenuto Maria Carolina, Rosignoli Daniele, Malincarne Lisa, Francisci Daniela
Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy.
Infect Dis Rep. 2024 Dec 17;16(6):1254-1262. doi: 10.3390/idr16060099.
The 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE) highlighted the essential role of multimodal imaging in the diagnostic algorithm of IE and its complications.
We hereby report a case series of IE in which the diagnosis was confirmed or excluded by the use of multimodal imaging during the period between January 2024 and July 2024 at the Infectious Diseases Clinic, Perugia Hospital, Italy.
Six patients were retrospectively included. Prosthetic valve endocarditis (PVE) was suspected in four patients and native valve endocarditis (NVE) in two cases. In patients with prosthetic valves, 18F FDG-PET/CT was performed, except in one case (P1) where cardiac CTA was performed for suspicion of perigraft aneurysm. Patients underwent transesophageal echocardiography (TOE), which was diagnostic in two cases and inconclusive in the remaining cases. In case of inconclusive TOE, the use of multimodal imaging added a major criterion and allowed us to consider (from 'rejected' to 'possible') or confirm (from 'possible' to 'definite') the diagnosis of EI based on the 2023 Duke-ESC Criteria. In one case (P6), it was possible to exclude the diagnosis. For patients with diagnostic TOE, 18F FDG-PET/CT allowed for the enhancement of diagnostic accuracy, identifying the site of valve involvement and the extension of the infection to the device (cases P3 and P5, respectively).
In clinical practice, the use of cardiac CTA and/or 18F FDG-PET/CT based on the latest ESC guidelines demonstrated a significant impact on the diagnosis and therapeutic management of IE.
2023年欧洲心脏病学会（ESC）感染性心内膜炎（IE）管理指南强调了多模态成像在IE及其并发症诊断流程中的重要作用。
我们在此报告一组IE病例系列，这些病例在2024年1月至2024年7月期间于意大利佩鲁贾医院传染病诊所通过多模态成像确诊或排除。
回顾性纳入6例患者。4例怀疑为人工瓣膜心内膜炎（PVE），2例为天然瓣膜心内膜炎（NVE）。对于人工瓣膜患者，除1例（P1）因怀疑移植物周围动脉瘤而行心脏CTA外，其余均行18F FDG-PET/CT检查。患者均接受了经食管超声心动图（TOE）检查，其中2例诊断明确，其余病例结果不明确。在TOE结果不明确的情况下，多模态成像的应用增加了一项主要标准，并使我们能够根据2023年杜克-ESC标准考虑（从“排除”到“可能”）或确诊（从“可能”到“明确”）EI诊断。在1例（P6）中，得以排除诊断。对于TOE诊断明确的患者，18F FDG-PET/CT提高了诊断准确性，分别确定了瓣膜受累部位以及感染向装置的扩展情况（分别为P3和P5病例）。
在临床实践中，根据最新的ESC指南使用心脏CTA和/或18F FDG-PET/CT对IE的诊断和治疗管理产生了重大影响。
