TY - JOUR
T1 - Clinical utility of 18F-FDG positron emission tomography/computed tomography scan vs. 99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis
AU - Lauridsen, Trine K
AU - Iversen, Kasper K
AU - Ihlemann, Nikolaj
AU - Hasbak, Philip
AU - Loft, Annika
AU - Berthelsen, Anne K
AU - Dahl, Anders
AU - Dejanovic, Danijela
AU - Albrecht-Beste, Elisabeth
AU - Mortensen, Jann
AU - Kjær, Andreas
AU - Bundgaard, Henning
AU - Bruun, Niels Eske
PY - 2017
Y1 - 2017
N2 - The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether18FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49-0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61-0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.
AB - The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether18FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49-0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61-0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.
KW - Aged
KW - Endocarditis/blood
KW - Female
KW - Fluorodeoxyglucose F18/administration & dosage
KW - Humans
KW - Leukocytes
KW - Male
KW - Middle Aged
KW - Observer Variation
KW - Positron Emission Tomography Computed Tomography
KW - Predictive Value of Tests
KW - Radiopharmaceuticals/administration & dosage
KW - Reproducibility of Results
KW - Single Photon Emission Computed Tomography Computed Tomography
KW - Technetium Tc 99m Exametazime/administration & dosage
U2 - 10.1007/s10554-016-1047-1
DO - 10.1007/s10554-016-1047-1
M3 - Journal article
C2 - 28050751
VL - 33
SP - 751
EP - 760
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
SN - 1569-5794
IS - 5
ER -