• Raphael Abegão de Camargo, Marcio Sommer Bitencourt, José Claudio Meneghetti, Jose Soares, Luís Fernando Tonello Gonçalves, Carlos Alberto Buchpiguel, Milena Ribeiro Paixão, Marilia Francesconi Felicio, de Matos SoeiroAlexandreAEmergency Unit, University of São Paulo Medical School, Brazil., Tania Mara Varejão Strabelli, Alfredo Jose Mansur, Flavio Tarasoutchi, Mucio Tavares de Oliveira, Bianchi CastelliJussaraJDepartment of Pathology, University of São Paulo Medical School, Brazil., Menosi GualandroDanielleDInterdisciplinary Medicine in Cardiology Unit, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Brazil., Lucas Zoboli Pocebon, Ron Blankstein, Abass Alavi, John Edmund Moore, Beverley Cherie Millar, and Rinaldo Focaccia Siciliano.
• Department of Nuclear Medicine, University of São Paulo Medical School, Brazil.
• Clin. Infect. Dis. 2020 Feb 3; 70 (4): 583-594.

Background18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding use of 18F-FDG-PET/CT for the diagnosis of native valve endocarditis (NVE).MethodsBetween 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. 18F-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE)/ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and 18F-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis.ResultsAmong 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of 18F-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were 22%, 100%, 100%, and 66%. The inclusion of abnormal 18F-FDG cardiac uptake as a major criterion at admission enabled a recategorization of 76% (47/62) of PVE/AAPI cases initially classified as "possible" to "definite" IE. In the histopathological analysis, a predominance of polymorphonuclear cell inflammatory infiltrate and a reduced extent of fibrosis were observed in the PVE group only.ConclusionsUse of 18F-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the modified Duke criteria. In patients who present with suspected NVE, the use of 18F-FDG-PET/CT is less accurate and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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