Improving the Diagnostic Performance of 18 F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography in Prosthetic Heart Valve Endocarditis.

Autor:	Swart LE; Department of Radiology and Nuclear Medicine (L.E.S., G.P.K., R.P.J.B.), Erasmus Medical Center, Rotterdam, The Netherlands.; Department of Cardiology (L.E.S., J.W.R.-H.), Erasmus Medical Center, Rotterdam, The Netherlands., Gomes A; Department of Medical Microbiology (A.G., B.S.), University of Groningen, University Medical Center Groningen, The Netherlands., Scholtens AM; Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands (A.M.S.)., Sinha B; Department of Medical Microbiology (A.G., B.S.), University of Groningen, University Medical Center Groningen, The Netherlands., Tanis W; Heartcenter, Haga Teaching Hospital, The Hague, The Netherlands (W.T.)., Lam MGEH; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, The Netherlands (M.G.E.H.L.)., van der Vlugt MJ; Department of Cardiology (M.J.v.d.V.), Radboud University Medical Center, Nijmegen, The Netherlands., Streukens SAF; Department of Cardiology (S.A.F.S.), Maastricht University Medical Center, The Netherlands., Aarntzen EHJG; Department of Radiology and Nuclear Medicine (E.H.J.G.A.), Radboud University Medical Center, Nijmegen, The Netherlands., Bucerius J; Department of Radiology and Nuclear Medicine (J.B.), Maastricht University Medical Center, The Netherlands.; Cardiovascular Research Institute Maastricht (J.B.), Maastricht University Medical Center, The Netherlands.; Department of Nuclear Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Germany (J.B.)., van Assen S; Department of Internal Medicine, Treant Care Group, Hoogeveen/Emmen/Stadskanaal, The Netherlands (S.v.A.)., Bleeker-Rovers CP; Department of Internal Medicine (C.P.B.-R.), Radboud University Medical Center, Nijmegen, The Netherlands., van Geel PP; Department of Cardiology (P.P.v.G., J.P.v.M.), University of Groningen, University Medical Center Groningen, The Netherlands., Krestin GP; Department of Radiology and Nuclear Medicine (L.E.S., G.P.K., R.P.J.B.), Erasmus Medical Center, Rotterdam, The Netherlands., van Melle JP; Department of Cardiology (P.P.v.G., J.P.v.M.), University of Groningen, University Medical Center Groningen, The Netherlands., Roos-Hesselink JW; Department of Cardiology (L.E.S., J.W.R.-H.), Erasmus Medical Center, Rotterdam, The Netherlands., Slart RHJA; Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center (R.H.J.A.S., A.W.J.M.G.), University of Groningen, University Medical Center Groningen, The Netherlands.; Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands (R.H.J.A.S.)., Glaudemans AWJM; Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center (R.H.J.A.S., A.W.J.M.G.), University of Groningen, University Medical Center Groningen, The Netherlands., Budde RPJ; Department of Radiology and Nuclear Medicine (L.E.S., G.P.K., R.P.J.B.), Erasmus Medical Center, Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Circulation [Circulation] 2018 Oct 02; Vol. 138 (14), pp. 1412-1427.
DOI:	10.1161/CIRCULATIONAHA.118.035032
Abstrakt:	Background: 18 F-Fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) was recently introduced as a new tool for the diagnosis of prosthetic heart valve endocarditis (PVE). Previous studies reporting a modest diagnostic accuracy may have been hampered by unstandardized image acquisition and assessment, and several confounders, as well. The aim of this study was to improve the diagnostic performance of FDG PET/CT in patients in whom PVE was suspected by identifying and excluding possible confounders, using both visual and standardized quantitative assessments. Methods: In this multicenter study, 160 patients with a prosthetic heart valve (median age, 62 years [43-73]; 68% male; 82 mechanical valves; 62 biological; 9 transcatheter aortic valve replacements; 7 other) who underwent FDG PET/CT for suspicion of PVE, and 77 patients with a PV (median age, 73 years [65-77]; 71% male; 26 mechanical valves; 45 biological; 6 transcatheter aortic valve replacements) who underwent FDG PET/CT for other indications (negative control group), were retrospectively included. Their scans were reassessed by 2 independent observers blinded to all clinical data, both visually and quantitatively on available European Association of Nuclear Medicine Research Ltd-standardized reconstructions. Confounders were identified by use of a logistic regression model and subsequently excluded. Results: Visual assessment of FDG PET/CT had a sensitivity/specificity/positive predictive value/negative predictive value for PVE of 74%/91%/89%/78%, respectively. Low inflammatory activity (C-reactive protein <40 mg/L) at the time of imaging and use of surgical adhesives during prosthetic heart valve implantation were significant confounders, whereas recent valve implantation was not. After the exclusion of patients with significant confounders, diagnostic performance values of the visual assessment increased to 91%/95%/95%/91%. As a semiquantitative measure of FDG uptake, a European Association of Nuclear Medicine Research Ltd-standardized uptake value ratio of ≥2.0 was a 100% sensitive and 91% specific predictor of PVE. Conclusions: Both visual and quantitative assessments of FDG PET/CT have a high diagnostic accuracy in patients in whom PVE is suspected. FDG PET/CT should be implemented early in the diagnostic workup to prevent the negative confounding effects of low inflammatory activity (eg, attributable to prolonged antibiotic therapy). Recent valve implantation was not a significant predictor of false-positive interpretations, but surgical adhesives used during implantation were.
Databáze:	MEDLINE
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