Pinheiro Ísis da Capela, Santiago Alysson Selton, Silva Vitor Deriquehem de Araújo, de Oliveira Lucas Ferreira, Alves Rebeca Maria Gomes Guimarães, Bucar Ana Glória, Mansur Filho João, Salis Lúcia Helena Alvares, de Souza E Silva Nelson Albuquerque, Ferreira Roberto Muniz
Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rio de Janeiro, RJ, Brazil, Rua Professor Rodolpho Paulo Rocco 255, University city, Rio de Janeiro, RJ, 21941-617, Brazil; Samaritano Hospital, Rio de Janeiro, RJ, Brazil, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ, 22251-050, Brazil.
Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rio de Janeiro, RJ, Brazil, Rua Professor Rodolpho Paulo Rocco 255, University city, Rio de Janeiro, RJ, 21941-617, Brazil.
Indian Heart J. 2025 Mar-Apr;77(2):93-97. doi: 10.1016/j.ihj.2025.03.008. Epub 2025 Mar 18.
To determine the role of nuclear imaging (NI) in evaluating inconclusive cases with suspicion of infective endocarditis (IE).
Consecutive patients with an indeterminate diagnosis of IE who underwent labelled leucocyte scintigraphy (LS) or F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) between 2018 and 2021 at 2 reference hospitals in Rio de Janeiro were retrospectively analysed. Subsequent confirmed or rejected diagnoses of IE were evaluated, in addition to clinical and imaging data. Kappa coefficient was used to compared the diagnostic agreement between echocardiographic and NI findings, with a p-value <0.05 considered statistically significant.
A total of 85 NI scans (28 FDG-PET/CT, 57 LS) from 76 patients were evaluated, of whom 48 (63.2 %) underwent only LS, 19 (25 %) only FDG-PET/CT, and 9 (11.8 %) both studies. Average age was 63.8 years (SD ± 18.5) and 51.3 % were women. Prosthetic valves were present in 15.8 % of cases, and intracardiac devices in 10.5 %. Among the 76 patients, 18 (23.7 %) had NI findings suggestive of IE. A total of 28 patients (36.8 %) were ultimately diagnosed with IE, 28.6 % of whom had confirmed infections by NI scans. Echocardiographic results had a low level of agreement with NI findings in those diagnosed with IE (kappa = -0.44).
Nuclear imaging contributed to the diagnosis of IE in approximately 30 % of subsequently confirmed cases, which were initially classified as inconclusive by echocardiography. The low level of agreement between these methods underscores their complementary role in the diagnosis of IE, particularly in indeterminate cases.
确定核成像（NI）在评估疑似感染性心内膜炎（IE）的不确定病例中的作用。
回顾性分析2018年至2021年期间在里约热内卢的两家参考医院接受标记白细胞闪烁扫描（LS）或氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）的IE诊断不确定的连续患者。除临床和影像数据外，还评估了随后确诊或排除的IE诊断。使用Kappa系数比较超声心动图和NI检查结果之间的诊断一致性，p值<0.05被认为具有统计学意义。
共评估了76例患者的85次NI扫描（28次FDG-PET/CT，57次LS），其中48例（63.2%）仅接受了LS检查，19例（25%）仅接受了FDG-PET/CT检查，9例（11.8%）接受了两项检查。平均年龄为63.8岁（标准差±18.5），女性占51.3%。15.8%的病例存在人工瓣膜，10.5%的病例存在心内装置。在76例患者中，18例（23.7%）的NI检查结果提示IE。共有28例患者（36.8%）最终被诊断为IE，其中28.6%的患者通过NI扫描确诊感染。在诊断为IE的患者中，超声心动图结果与NI检查结果的一致性较低（kappa=-0.44）。
核成像在约30%随后确诊的病例中对IE的诊断有帮助，这些病例最初经超声心动图分类为不确定。这些方法之间的低一致性强调了它们在IE诊断中的互补作用，特别是在不确定的病例中。
