Utilization of FDG-PET/CT in the diagnosis of native valve endocarditis: There is a hope, but we need more data!

Excerpt

Infective endocarditis (IE) diagnosis and management require a multidisciplinary approach, and cardiac imaging plays an important role. Echocardiography—both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE)—is a cornerstone in the diagnosis of patients with IE as a part of the Modified Duke Criteria.1 However, echocardiography findings could be equivocal or difficult to interpret in some instances. In 2015, the American Heart Association (AHA) and European Society of Cardiology (ESC) published documents—the AHA acknowledged the potentials of advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), and cardiac CT, with no recommendation; however, the ESC recommended the utilization of both FDG-PET/CT and cardiac CT in the diagnosis of IE.2,3 As per the 2015 ESC guidelines, both FDG-PET/CT and cardiac CT have the potentials in reclassifying the “possible IE” category to the “definite IE” category and in the detection of septic embolic foci throughout the body.3 In particular, the 2015 ESC guidelines recommended the use of FDG-PET/CT along with cardiac CT in patients with possible prosthetic heart valve endocarditis (PVE) as per the Modified Duke Criteria. Since these recommendations, a growing body of literature investigated the use of FDG-PET/CT in the diagnosis of IE. …