18F-FDG PET/CT for early detection of embolism and metastatic infection in patients with infective endocarditis

• DOI: 10.1007/s00259-010-1380-x
• Publication Date: 2010-03-03T14:21:13Z
• Authors: Jelle Van Riet; Evelyn E. Hill; Olivier Gheysens; Steven Dymarkowski; Marie-Christine H...; Paul Herijgers; Willy E. Peetermans; Luc Mortelmans
• Keywords: Infective Endocarditis; Occult

In the acute setting of endocarditis it is very important to assess both the vegetation itself, as well as potential life-threatening complications, in order to decide whether antibiotic therapy will be sufficient or urgent surgery is indicated. A single whole-body scan investigating inflammatory changes could be very helpful to achieve a swift and efficient assessment.In this study we assessed whether (18)F-FDG can be used to detect and localize peripheral embolism or distant infection. Twenty-four patients with 25 episodes of endocarditis, enrolled between March 2006 and February 2008, underwent (18)F-FDG PET/CT imaging on a dedicated PET/CT scanner.PET/CT imaging revealed a focus of peripheral embolization and/or metastatic infection in 11 episodes (44%). One episode had a positive PET/CT scan result for both embolism and metastatic infection. PET/CT detected seven positive cases (28%) in which there was no clinical suspicion. Valve involvement of endocarditis was seen only in three patients (12%).PET/CT may be an important diagnostic tool for tracing peripheral embolism and metastatic infection in the acute setting of infective endocarditis, since a PET/CT scan detected a clinically occult focus in nearly one third of episodes.