18F-FDG PET/CT in the diagnosis of prosthetic valve endocarditis

Recent studies have shown promising results using F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT) in the diagnosis of prosthetic valve endocarditis (PVE). However, previous studies did not include negative controls. The aim of this study was to compare F-18-FDG-uptake around prosthetic aortic valves in patients with and without PVE and to determine the diagnostic performance of F-18-FDG PET/CT in the diagnosis of PVE. F-18-FDG PET/CT examinations in patients with a prosthetic aortic valve performed 2008-2014 were retrieved. Eight patients with a final diagnosis of definite PVE were included in the analysis of the diagnostic performance of F-18-FDG PET/CT. Examinations performed on suspicion of malignancy in patients without PVE (n = 19) were used as negative controls. Visual and semi-quantitative analysis was performed. Maximal standardized uptake value (SUVmax) in the valve area was measured and SUVratio was calculated by dividing valve SUVmax by SUVmax in the descending aorta. The sensitivity was 75 %, specificity 84 %, positive likelihood ratio [LR(+)] 4.8 and negative likelihood ratio [LR(-)] 0.3 on visual analysis. Both SUVmax and SUVratio were significantly higher in PVE patients [5.8 (IQR 3.5-6.5) and 2.4 (IQR 1.7-3.0)] compared to non-PVE patients [3.2 (IQR 2.8-3.8) and 1.5 (IQR 1.3-1.6)] (p < 0.001). ROC-curve analysis of SUVratio yielded an area under the curve of 0.90 (95 % CI 0.74-1.0). F-18-FDG-uptake around non-infected aortic prosthetic valves was low. The level of F-18-FDG-uptake in the prosthetic valve area showed a good diagnostic performance in the diagnosis of PVE.