A prospective study with 72 patients showed that adding abnormal FDG uptake around a prosthetic valve to the modified Duke criteria at admission increased the sensitivity for the diagnosis of prosthetic valve endocarditis from 70% to 97% [32]. Another smaller prospective study showed that adding PET/CT to the modified Duke criteria in patients with an intermediate probability of infective endocarditis and an implantable cardiac device increased diagnostic accuracy [33]. However, when looking at a cohort of patients with native and prosthetic valves, one study showed a relatively low sensitivity of 39% for the diagnosis of infectious endocarditis [29]. Another retrospective study showed a sensitivity of 0% for diagnosing native valve endocarditis when compared with the modified Duke criteria [30]. In patients with congenital heart disease and intravascular or intracardiac prosthetic material, one prospective study showed that the use of PET/CT in addition to the modified Duke criteria, increased the diagnostic accuracy from 61.2% to 85.1% [34]. Fluoroscopy Heart There are no data to support the use of cardiac fluoroscopy in suspected infective endocarditis. On rare occasions, cardiac fluoroscopy may be indicated for evaluating mechanical prosthetic cardiac valves afflicted with endocarditis [35]. Valve fluoroscopy is used to detect excess mobility of the mechanical prosthetic valve during the cardiac cycle (a finding highly suggestive of valve dehiscence due to infective endocarditis) or to detect immobility of mechanical prosthetic valve leaflets secondary to infected pannus or thrombus. WBC Scan Heart White blood cells (WBCs) may be labeled with either indium-111 (In-111), Tc-99m, or gallium-67 (Ga-67) [36]. There is limited evidence in the literature for the use of WBC scans in suspected infective endocarditis. One center reported a sensitivity of 0% for the detection of valvular vegetations by In-111 WBC in 7 patients with known vegetations seen by TEE [37].
Infective Endocarditis. A prospective study with 72 patients showed that adding abnormal FDG uptake around a prosthetic valve to the modified Duke criteria at admission increased the sensitivity for the diagnosis of prosthetic valve endocarditis from 70% to 97% [32]. Another smaller prospective study showed that adding PET/CT to the modified Duke criteria in patients with an intermediate probability of infective endocarditis and an implantable cardiac device increased diagnostic accuracy [33]. However, when looking at a cohort of patients with native and prosthetic valves, one study showed a relatively low sensitivity of 39% for the diagnosis of infectious endocarditis [29]. Another retrospective study showed a sensitivity of 0% for diagnosing native valve endocarditis when compared with the modified Duke criteria [30]. In patients with congenital heart disease and intravascular or intracardiac prosthetic material, one prospective study showed that the use of PET/CT in addition to the modified Duke criteria, increased the diagnostic accuracy from 61.2% to 85.1% [34]. Fluoroscopy Heart There are no data to support the use of cardiac fluoroscopy in suspected infective endocarditis. On rare occasions, cardiac fluoroscopy may be indicated for evaluating mechanical prosthetic cardiac valves afflicted with endocarditis [35]. Valve fluoroscopy is used to detect excess mobility of the mechanical prosthetic valve during the cardiac cycle (a finding highly suggestive of valve dehiscence due to infective endocarditis) or to detect immobility of mechanical prosthetic valve leaflets secondary to infected pannus or thrombus. WBC Scan Heart White blood cells (WBCs) may be labeled with either indium-111 (In-111), Tc-99m, or gallium-67 (Ga-67) [36]. There is limited evidence in the literature for the use of WBC scans in suspected infective endocarditis. One center reported a sensitivity of 0% for the detection of valvular vegetations by In-111 WBC in 7 patients with known vegetations seen by TEE [37].