Impact of a dedicated cardiac protocol on diagnosis of infective endocarditis in patients undergoing 18F-FDG-thoracic digital-PET/CT - Effects of expertise level

• Published in: Journal of nuclear cardiology 2024-09, Vol.39, p.102010
• Main Authors: Notohamiprodjo, Susan, Scheidhauer, Klemens, Eiber, Matthias, Yakushev, Igor, Villagran Asiares, Alberto, Kraus-Deuringer, Julia, Krebs-Fleischmann, Helge W A, Kleiner, Sebastian, Eggerstedt, Robert, Eglseder, Bettina, Weber, Wolfgang A, Nekolla, Stephan G
• Format: Article
• Language: English
• ISSN: 1532-6551; 1532-6551
• DOI: 10.1016/j.nuclcard.2024.102010

This study aimed to assess the impact of dedicated cardiac protocol (DCP) on diagnostic accuracy of state-of-the-art digital [18F]-FDG-PET/CT in infective endocarditis (IE) and the intra-individual comparison of the performance with that of conventional whole-body approach (WBA) and to analyze the effects of the expertise level of the investigators.BACKGROUNDThis study aimed to assess the impact of dedicated cardiac protocol (DCP) on diagnostic accuracy of state-of-the-art digital [18F]-FDG-PET/CT in infective endocarditis (IE) and the intra-individual comparison of the performance with that of conventional whole-body approach (WBA) and to analyze the effects of the expertise level of the investigators.44 patients suspected for IE underwent digital-FDG-PET/CT after overnight fasting. Each three consultants and trainees reread PET images blinded to the examination approach and clinical information. Visual and semiquantitative analyses were performed.METHODS44 patients suspected for IE underwent digital-FDG-PET/CT after overnight fasting. Each three consultants and trainees reread PET images blinded to the examination approach and clinical information. Visual and semiquantitative analyses were performed.Digital-FDG-PET/CT with DCP revealed sensitivity, specificity, and accuracy of 89%, 93%, and 91% for native valve endocarditis (NVE) and 93%, 86%, and 91% for prosthetic valve endocarditis. Compared to WBA, substantial improvement of the diagnostic performance for NVE in DCP was evident, especially in trainees, but not as high compared to consultants. Digital-FDG-PET/CT enabled 79.5% reclassification of modified-Duke-Clinical-Criteria (mDC) with 34.1% upgrading and 45.4% downgrading.RESULTSDigital-FDG-PET/CT with DCP revealed sensitivity, specificity, and accuracy of 89%, 93%, and 91% for native valve endocarditis (NVE) and 93%, 86%, and 91% for prosthetic valve endocarditis. Compared to WBA, substantial improvement of the diagnostic performance for NVE in DCP was evident, especially in trainees, but not as high compared to consultants. Digital-FDG-PET/CT enabled 79.5% reclassification of modified-Duke-Clinical-Criteria (mDC) with 34.1% upgrading and 45.4% downgrading.This study provides new data using state-of-the-art digital-FDG-PET/CT with DCP improving the diagnostic accuracy in challenging cases of possible IE, particularly in NVE, provided that the investigators involved have the necessary expertise. These findings may have a significant impact on IE-re