The Contribution of [18F] FDG PET/CT in the Diagnosis of Prosthetic Valve Infective Endocarditis
A Case Report
DOI:
https://doi.org/10.59667/sjoranm.v24i1.20Abstract
Introduction: Infective endocarditis is a potentially life-threatening disease that requires rapid and accurate diagnosis. Recently, [18F] FDG PET/CT has been incorporated as a new major criterion for the diagnosis of infective endocarditis.
Case Report: This report describes a 54-year-old female patient who underwent mitral valve replacement in 2018 for symptomatic severe mitral stenosis with atrial fibrillation. She presented with infectious symptoms on clinical examination. Following transthoracic and transesophageal echocardiography, the differential diagnosis included prosthetic valve infective endocarditis versus mechanical prosthesis thrombosis. [18F] FDG PET/CT ultimately confirmed the diagnosis of prosthetic valve infective endocarditis.
Conclusion: This case highlights the significant advantages of [18F] FDG PET/CT in the diagnostic evaluation of patients with suspected prosthetic valve infective endocarditis, particularly when conventional echocardiographic examinations are inconclusive.
Keywords: Endocarditis, Fluorodeoxyglucose F18, Positron Emission Tomography
References
1. Cahill TJ, Prendergast BD. Infective endocarditis. Lancet. 2016 ;387(10021):882-93. https://doi.org/10.1016/S0140-6736(15)00067-7
2. Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, et al. Global and regional burden of infective endocarditis, 1990-2010: a systematic review of the literature. Glob Heart. 2014;9(1):131-43. https://doi.org/10.1016/j.gheart.2014.01.002
3. Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015;65(19):2070-6. https://doi.org/10.1016/j.jacc.2015.03.518
4. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009;169(5):463-73. https://doi.org/10.1001/archinternmed.2008.603
5. Gobbo MY, Meretta AH, Rosa D, Corneli M, Daquarti GJ, Masoli OH, et al. Tomografía por emisión de positrones en endocarditis infecciosa asociada a dispositivos y válvulas protésicas. Medicina (B Aires). 2020;80(1):17-22. https://pubmed.ncbi.nlm.nih.gov/32044737/
6. Fowler VG, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis AL, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis. 2023 ;77(4):518-526. https://doi.org/10.1093/cid/ciad510
7. Vaidyanathan S, Patel CN, Scarsbrook AF, Chowdhury FU. FDG PET/CT in infection and inflammation–current and emerging clinical applications. Clin. Radiol. 2015, 70, 787–800. https://doi.org/10.1016/j.crad.2015.03.010
8. Chen W, Sajadi MM, Dilsizian V. Merits of FDG PET/CT and Functional Molecular Imaging Over Anatomic Imaging With Echocardiography and CT Angiography for the Diagnosis of Cardiac Device Infections. JACC Cardiovasc Imaging. 2018;11(11):167991. https://doi.org/10.1016/j.jcmg.2018.08.026
9. Lancellotti P, Habib G, Oury C, Nchimi A. Positron Emission Tomography/Computed Tomography Imaging in Device Infective Endocarditis: Ready for Prime Time. Circulation. 2015;132(12):107680. https://doi.org/10.1161/CIRCULATIONAHA.115.018521
10. Aguadé Bruix S, Roque Pérez A, Cuéllar Calabria H, Pizzi MN. Cardiac 18F-FDG PET/CT procedure for the diagnosis of prosthetic endocarditis and intracardiac devices. Rev Esp Med Nucl Imagen Mol (Engl Ed). 2018;37(3):163-171. https://doi.org/10.1016/j.remn.2018.01.002
11. Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H et al. ESC guidelines for the management of endocarditis. Eur Heart J. 2023 ;44(39):3948–4042. https://doi.org/10.1093/eurheartj/ehae877
12. Erba PA, Sollini M, Conti U, Bandera F, Tascini C, De Tommasi SM, et al. Radiolabeled WBC scintigraphy in the diagnostic workup of patients with suspected device-related infections. JACC Cardiovasc Imaging. 2013;6:1075–1086. https://doi.org/10.1016/j.jcmg.2013.08.001
13. Erba PA, Conti U, Lazzeri E, Sollini M, Doria R, De Tommasi SM, et al. Added value of 99mTc-HMPAO-labeled leukocyte SPECT/CT in the characterization and management of patients with infectious endocarditis. J Nucl Med. 2012;53:1235–1243. https://doi.org/10.2967/jnumed.111.099424
14. Gotthardt M, Bleeker-Rovers CP, Boerman OC, Oyen WJ. Imaging of inflammation by PET, conventional scintigraphy, and other imaging techniques. J Nucl Med. 2010;51:1937–1949. https://doi.org/10.2967/jnumed.110.076232
15. Gomes A, Glaudemans AWJM, Touw DJ, van Melle JP, Willems TP, Maass AH, et al. Diagnostic value of imaging in infective endocarditis: a systematic review. Lancet Infect Dis. 2017 Jan;17(1):e1-e14. https://doi.org/10.1016/S1473-3099(16)30141-4
Downloads
Published
License
Copyright (c) 2025 Zakaria Ouassafrar, Abdel Amide Gbadamassi, Halima Batani, Hafsa Bensimimoun, Amal Guensi

This work is licensed under a Creative Commons Attribution 4.0 International License.
This license requires that reusers give credit to the creator. It allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, even for commercial purposes.


