Department of Nuclear Medicine, Armed Forces Medical College, Pune, India
Department of Rheumatology, Armed Forces Medical College, Pune, India
The diagnosis of prosthetic valve endocarditis continues to present a diagnostic challenge, due to the lower sensitivity of the modified Duke criteria and a higher percentage of negative or inconclusive echocardiography results. Diagnostic delay might result in significant morbidity/mortality. Imaging modalities like 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT), prove to be an added diagnostic modality in such cases, thus assisting the accuracy of diagnosis by the modified-Duke-criteria. [18F]FDG PET/CT can prove highly beneficial, provided proper preparation for adequate suppression of the physiological myocardial uptake is done prior to the scan, thus helping is semi-quantitative analysis of the infected focus. We herein, report a case of suspected infective endocarditis with known prior history of a prosthetic valve in situ where the diagnosis of infective endocarditis could not be established with conviction, despite the use of conventional modalities of imaging like 2D echocardiography. [18F]FDG PET/CT proved its mettle by determining the primary site of infection, as well as metastatic extra-cardiac infective foci, and thus avoiding morbidity arising out of delayed diagnosis.
Gupta R. Infective Endocarditis: Indian Scenario. Available from: http://apiindia.org/wp-content/uploads/medicine_update_2013/chap29.pdf.
Holland TL, Baddour LM, Bayer AS, Hoen B, Miro JM, Fowler VG Jr. Infective endocarditis. Nat Rev Dis Primers. 2016;(2):16059.
Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P, Sinha N. Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992-2001. Int J Cardiol. 2005 Feb 15;98(2):253-60.
Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Vhu VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective endocarditis: a systematic review of the literature. Glob Heart. 2014 Mar;9(1):131-43.
Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler Jr VG, Bayer AS, Karchmer AW, International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Internal Med. 2009 Mar 9;169(5):463-73.
Cheng CW, Feng CM, Chua CS. Invasive pyogenic infection and infective endocarditis due to Streptococcus anginosus: A case report. Medicine (Baltimore). 2019;98(48):e18156.
Chen F, Zhang Z, Chen J. Infective endocarditis caused by Lactococcus lactis subsp. Lactis and Pediococcus pentosaceus: A case report and literature review. Medicine (Baltimore). 2018;97(50):e13658.
Nuvoli S, Fiore V, Babudieri S. The additional role of 18F-FDG PET/CT in prosthetic valve endocarditis. Eur Rev Med Pharmacol Sci. 2018;22(6):1744-1751.
Chen W, Dilsizian V. FDG PET/CT for the diagnosis and management of infective endocarditis: Expert consensus vs evidence-based practice. J Nucl Cardiol. 2019; 26:313-315.
Harding D, Prendergast B. Advanced imaging improves the diagnosis of infective endocarditis. F1000Res. 2018 May 29;7:F1000 Faculty Rev-674.
Vidal V, Albiach C, Gradolí J. 18F-FDG PET/CT in the diagnosis of prosthetic valve endocarditis. Rev Port Cardiol (Engl Ed). 2018 Aug;37(8):717.e1-717.e5.
Vos FJ, Bleeker-Rovers CP, Sturm PD. 18F-FDG PET/CT for detection of metastatic infection in gram-positive bacteremia. J Nucl Med. 2010;51(8):1234-1240.
Osborne MT, Hulten EA, Murthy VL, Skali H, Taqueti VR, Dorbala S, DiCarli MF, Blankstein R. Patient preparation for cardiac fluorine-18 fluorodeoxyglucose positron emission tomography imaging of inflammation. J Nucl Cardiol. 2017 Feb;24(1):86-99.
Jiménez-Ballvé A, Pérez-Castejón MJ, Delgado-Bolton RC. Assessment of the diagnostic accuracy of 18F-FDG PET/CT in prosthetic infective endocarditis and cardiac implantable electronic device infection: comparison of different interpretation criteria. Eur J Nucl Med Mol Imaging. 2016;43(13):2401-2412.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL; ESC Scientific Document Group. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015 Nov 21;36(44):3075-3128.
Martin O, Aissa J, Boos J. Impact of different metal artifact reduction techniques on attenuation correction in 18F-FDG PET/CT examinations. Br J Radiol. 2020 Jan;93(1105):20190069.
Jain, A., Hegde, A., Kumar, A. A., Sharma, A., & Husain, A. (2022). Detection of extra-cardiac hypermetabolic foci by [18F]FDG PET/CT in case of infective endocarditis and post antibiotic therapy response assessment. Iranian Journal of Nuclear Medicine, 30(1), 67-71.
Anurag Jain; Arun Hegde; AVS Anil Kumar; Amit Sharma; Azhar Husain. "Detection of extra-cardiac hypermetabolic foci by [18F]FDG PET/CT in case of infective endocarditis and post antibiotic therapy response assessment". Iranian Journal of Nuclear Medicine, 30, 1, 2022, 67-71.
Jain, A., Hegde, A., Kumar, A. A., Sharma, A., Husain, A. (2022). 'Detection of extra-cardiac hypermetabolic foci by [18F]FDG PET/CT in case of infective endocarditis and post antibiotic therapy response assessment', Iranian Journal of Nuclear Medicine, 30(1), pp. 67-71.
Jain, A., Hegde, A., Kumar, A. A., Sharma, A., Husain, A. Detection of extra-cardiac hypermetabolic foci by [18F]FDG PET/CT in case of infective endocarditis and post antibiotic therapy response assessment. Iranian Journal of Nuclear Medicine, 2022; 30(1): 67-71.