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Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques
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 o...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174257/ https://www.ncbi.nlm.nih.gov/pubmed/30066279 http://dx.doi.org/10.1007/s12350-018-1383-8 |
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author | Gomes, Anna van Geel, Peter Paul Santing, Michiel Prakken, Niek H. J. Ruis, Mathilde L. van Assen, Sander Slart, Riemer H. J. A. Sinha, Bhanu Glaudemans, Andor W. J. M. |
author_facet | Gomes, Anna van Geel, Peter Paul Santing, Michiel Prakken, Niek H. J. Ruis, Mathilde L. van Assen, Sander Slart, Riemer H. J. A. Sinha, Bhanu Glaudemans, Andor W. J. M. |
author_sort | Gomes, Anna |
collection | PubMed |
description | 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 (18)F-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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12350-018-1383-8) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7174257 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-71742572020-04-23 Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques Gomes, Anna van Geel, Peter Paul Santing, Michiel Prakken, Niek H. J. Ruis, Mathilde L. van Assen, Sander Slart, Riemer H. J. A. Sinha, Bhanu Glaudemans, Andor W. J. M. J Nucl Cardiol Original Article 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 (18)F-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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12350-018-1383-8) contains supplementary material, which is available to authorized users. Springer International Publishing 2018-07-31 2020 /pmc/articles/PMC7174257/ /pubmed/30066279 http://dx.doi.org/10.1007/s12350-018-1383-8 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Gomes, Anna van Geel, Peter Paul Santing, Michiel Prakken, Niek H. J. Ruis, Mathilde L. van Assen, Sander Slart, Riemer H. J. A. Sinha, Bhanu Glaudemans, Andor W. J. M. Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques |
title | Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques |
title_full | Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques |
title_fullStr | Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques |
title_full_unstemmed | Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques |
title_short | Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques |
title_sort | imaging infective endocarditis: adherence to a diagnostic flowchart and direct comparison of imaging techniques |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174257/ https://www.ncbi.nlm.nih.gov/pubmed/30066279 http://dx.doi.org/10.1007/s12350-018-1383-8 |
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