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Utilization of 18-FDG-PET/CT in the diagnosis of native valve endocarditis
Session:
Posters (Sessão 5 - Écran 3) - Imagem multimodal 2
Speaker:
Gonçalo Terleira Batista
Congress:
CPC 2023
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Gonçalo Terleira Batista; Gonçalo Ferraz Costa; Ana Luísa Silva; Mariana Simões; Tatiana Santos; Eric Monteiro; Joana Guimarães; Diogo Fernandes; Rafaela Fernandes; Ana Vera Marinho; Gracinda Costa; Rodolfo Silva; Lino Gonçalves; M.J. Ferreira
Abstract
<p><strong>Background: </strong>The diagnosis of infective endocarditis (IE) remains a clinical challenge. Diagnostic accuracy of the modified Duke criteria is suboptimal for native valve endocarditis (NVE) and even worse in the presence of prosthetic material-related infection (PVE). We aim to evaluate the diagnostic performance of 18F-FDG PET in patients with suspected IE referred to perform PET/CT.</p> <p><strong>Purpose:</strong> We aim to understand the diagnostic value of 18F-FDG PET/CT in suspected NVE.</p> <p><strong>Methods:</strong> A retrospective study was performed at a tertiary center with 18F-FDG PET/CT and included all referred patients for this exam for suspected IE between May 2016 and January 2022. The choice to perform 18F-FDG PET/CT and the IE suspicion was based on the attending endocarditis team and did not follow a standardized protocol. Baseline demographic characteristics of patients, including all relevant clinical data, were collected from hospital records at hospital admission. The final diagnosis of IE (gold standard) was established by consulting the final diagnosis attributed to the patient by the Endocarditis team at the time of hospital discharge or death, after possession of clinical, microbiological, and imaging information as well as clinical response. Sensitivity, specificity, and positive and negative predictive values of 18F-FDG PET/CT in the evaluation of NVE were estimated.</p> <p><strong>Results:</strong> In total, 87 patients were included (mean age of 62 +/- 19 years, 62% of the male gender), of which 32 had NVE suspicion. From this subgroup, approximately 56% were male, with a median age of 53.5 (IQR 41.5-71) years. Moreover, 22% were diabetic, 28% had dyslipidemia and 45% were hypertensive. Fever was present in 84% of patients and 16% had signs of heart failure. No patients had signs of vascular or immunological phenomena, nor signs of systemic septic embolization. Laboratory tests showed a mean CRP of 16.2 mg/dL and a mean leucocyte count of 10.9 G/L. Furthermore, 50% had at least one positive blood culture. 37.5% had echocardiographic findings suggesting IE with the presence of vegetations in all of them. According to the Duke Criteria, 50% were classified as "possible diagnosis", 16% with "definitive diagnosis"; and 34% as "rejected diagnosis". Of the 32 suspected NVE patients, 8 had a definitive diagnosis of IE, with compatible findings in 18F-FDG PET/CT observed in 5. Calculated sensibility was 62.5% and specificity was 100%.</p> <p><strong>Conclusion:</strong> Our study suggests that 18F-FDG PET/CT is an imaging tool of great specificity but poor sensibility for NVE.</p>
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