FDG PET/CT in Prosthetic Heart Valve Endocarditis

Abstract

18F-fluorodeoxyglucose positron emission tomography with computed tomographic attenuation correction (FDG PET/CT) is an imaging technique used, among other indications, to demonstrate inflammatory processes including infections. In this doctoral research, we further evaluated the role of FDG PET/CT in demonstrating infections of or around prosthetic valves implanted in the heart (prosthetic heart valve endocarditis). Prosthetic heart valve endocarditis is a disease associated with a high risk of mortality, where a rapid and accurate diagnosis is crucial. Based on the findings of our study, we propose improvements regarding patient preparation prior to imaging, the acquisition of the imaging itself, and the interpretation of the images obtained. The main outcomes were firstly that the use of Heparin as a single administration, coupled with a carbohydrate-restricted diet on the day before FDG PET/CT, results in more interpretable images. Secondly, that the use of standardized processing of the images, applying modern reconstruction techniques, leads to interpretable images on which measurements can be performed that are comparable between different hospitals. Finally, we confirmed these techniques by applying them to a large group of FDG PET/CT studies collected in multiple hospitals in the Netherlands, and demonstrated that both the sensitivity and accuracy of FDG PET/CT for prosthetic valve endocarditis can be increased by their use.