Advantages of 18F-FDG PET/CT Imaging over Modified Duke Criteria and Clinical Presumption in Patients with Challenging Suspicion of Infective Endocarditis

According to European Society of Cardiology guidelines (ESC2015) for infective endocarditis (IE) management, modified Duke criteria (mDC) are implemented with a degree clinical suspicion degree, leading grades such as “possible” or “rejected” IE despite persisting high level suspicion. Herein, we evaluate the 18F-FDG PET/CT diagnostic and therapeutic impact in suspicion, emphasis on possible/rejected Excluding cases definite diagnosis, 53 patients who underwent were selected afterwards classified according both mDC (possible IE/Duke 1, rejected 0) (high low suspicion). The final status regarding diagnosis (gold standard) was based multidisciplinary decision Endocarditis Team, including ‘imaging specialist’. images cardiac area qualitatively interpreted intensity each focus extra-physiologic uptake evaluated by maximum standardized value (SUVmax) measurement. Extra-cardiac pathological findings considered be possible embolic event, source IE, even concomitant infection. Based Team consensus, retained 19 (36%) excluded 34 (64%). With sensitivity, specificity, positive predictive (PPV), negative (NPV), global accuracy 79%, 100%, 89%, 92%, respectively, performed significantly better than (p = 0.003), 0.001), combination 0.001) diagnosis. In 41 but PPV, NPV, accuracies 78%, 85%, 90%, respectively. Moreover, contributed patient management 24 out (45%) cases. represents valuable tool that could proposed challenging significant differences between degree. allows binary (definite IE) removing uncertain situations, thus improving management.