Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques

Anna Gomes*, Peter Paul van Geel, Michiel Santing, Niek H J Prakken, Mathilde L Ruis, Sander van Assen, Riemer H J A Slart, Bhanu Sinha, Andor W J M Glaudemans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: Multimodality imaging is recommended to diagnose infective endocarditis. Value of additional imaging to echocardiography in patients selected by a previously proposed flowchart has not been evaluated.

METHODS: An observational single-center study was performed. Adult patients suspected of endocarditis/device infection were prospectively and consecutively enrolled from March 2016 to August 2017. Adherence to a diagnostic imaging-in-endocarditis-flowchart was evaluated in 176 patients. Imaging techniques were compared head-to-head in 46 patients receiving echocardiography (transthoracic plus transesophageal), multi-detector computed tomography angiography (MDCTA), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT).

RESULTS: 69% of patients (121/176) adhered to the flowchart. Sensitivity of echocardiography, MDCTA, FDG-PET/CT in patients without prosthesis was 71%, 57%, 29% (86% when combined), while specificity was 100%, 75%, 100%, respectively. Sensitivity in patients with prosthesis was 75%, 75%, 83%, respectively (100% when combined), while specificity was 86% for all three modalities. Echocardiography performed best in the assessment of vegetations, morphological valve abnormalities/dehiscence, septum defects, and fistula formation. MDCTA performed best in the assessment of abscesses and ventricular assist device infection. FDG-PET/CT performed best in the assessment of cardiac device infection, extracardiac infectious foci, and alternative diagnoses.

CONCLUSIONS: This study demonstrates that the evaluated imaging-in-endocarditis-flowchart is applicable in daily clinical practice. Echocardiography, MDCTA, and FDG-PET/CT provide relevant complementary diagnostic information, particularly in patients with intracardiac prosthetic material.

Original languageEnglish
Pages (from-to)592-608
Number of pages17
JournalJournal of Nuclear Cardiology
Issue number2
Early online date31-Jul-2018
Publication statusPublished - Apr-2020


  • Echo
  • CT
  • PET
  • valvular heart disease
  • infection
  • diagnostic and prognostic application
  • F-18-FDG PET/CT

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