The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis

• Published in: Clinical microbiology and infection Vol. 21; no. 1; pp. 69 - 76
• Main Authors: Orvin, K., Goldberg, E., Bernstine, H., Groshar, D., Sagie, A., Kornowski, R., Bishara, J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2015
• Subjects: 18fluorodeoxyglucose–positron emission tomography/computed tomography; Adult; Aged; complications; embolic events; endocarditis; Endocarditis - complications; Endocarditis - epidemiology; Endocarditis - therapy; extra-cardiac; Female; Fluorodeoxyglucose F18; Hospitalization; Humans; Male; Middle Aged; Positron-Emission Tomography; Thromboembolism - diagnosis; Thromboembolism - epidemiology; Thromboembolism - etiology; Thromboembolism - therapy; Tomography, X-Ray Computed; 18fluorodeoxyglucose–positron emission tomography/computed tomography; endocarditis; complications; extra-cardiac; embolic events; fluorodeoxyglucose–positron emission tomography/computed tomography
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1016/j.cmi.2014.08.012

The exact incidence of extra-cardiac complications (ECC) in patients with infective endocarditis (IE) is unknown but presumed to be high. These patients, although mostly asymptomatic, may require a more aggressive therapeutic approach. 18fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) is used for the diagnosis of infections, but its role in the early diagnosis of IE complications is still unclear. This study aimed to evaluate the role of FDG-PET/CT in the early diagnosis of ECC in IE and its implications for medical management. We prospectively studied 40 consecutive patients with a confirmed diagnosis of IE (according to the modified Duke criteria) who underwent a whole body FDG-PET/CT study within 14 days from diagnosis. The FDG-PET/CT demonstrated ECC in 17 (42.5%) patients, while 8 (38.1%) of them were asymptomatic. The most frequent embolic sites were musculoskeletal and splenic. Owing to the FDG-PET/CT findings, treatment planning was modified in 14 (35%) patients. This included antibiotic treatment prolongation (27.5%), referral to surgical procedures (15%) and, most substantially, prevention of unnecessary device extraction (17.7%). According to our experiences, FDG-PET/CT imaging was useful in the detection of embolic and metastatic infections in IE. This clinical information had a significant diagnostic and therapeutic impact in managing IE disease.