RESUMO
OBJECTIVES: Infective endocarditis (IE) and cardiac device infection (CDI) are a major complication in the growing number of patients with congenital heart disease (CHD) reaching adulthood. We aimed to evaluate the added value of 18F-FDG-PET/CT angiography (PET/CTA) in the diagnosis of IE-CDI in adults with CHD and intravascular or intracardiac prosthetic material, in whom echocardiography (ECHO) and modified Duke Criteria (DC) have limitations because of the patients' complex anatomy. METHODS: A prospective study was conducted in a referral center with multidisciplinary IE and CHD Units. PET/CTA and ECHO findings were compared in consecutive adult (≥18years) patients with CHD who have prosthetic material and suspected IE-CDI. The initial diagnosis using the DC and the diagnosis with the additional PET/CTA data (DC+PET/CTA) were compared with the final diagnostic consensus established by an expert team at three months. RESULTS: Between November-2012 and April-2017, 25 patients (15 men; median age 40years) were included. Cases were initially classified as definite in 8 (32%), possible in 14 (56%) and rejected in 3 (12%). DC+PET/CTA allowed reclassification of 12/14 (86%) cases initially identified as possible IE. The sensitivity, specificity, PPV, NPV, and accuracy of DC at IE suspicion were 39.1%/83.3%/90.4%/25.5%/61.2%, respectively. The diagnostic performance increased significantly with addition of PET/CTA data: 87%/83.3%/95.4%/61.5%/85.1%, respectively. PET/CTA also provided an alternative diagnosis in 3 patients with rejected IE, and detected pulmonary embolisms in 3 patients. CONCLUSIONS: PET/CTA was a useful diagnostic tool in the complex group of adult patients with CHD who have cardiac or intravascular prosthetic material and suspected IE or CDI, providing added diagnostic value to the modified DC (increased sensitivity) and improving case classification.
Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/etiologia , Contaminação de Equipamentos , Fluordesoxiglucose F18 , Próteses Valvulares Cardíacas/microbiologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Adulto , Endocardite/diagnóstico por imagem , Endocardite/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Angiografia por Tomografia Computadorizada , Endocardite Bacteriana/diagnóstico por imagem , Endocardite não Infecciosa/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Endocardite Bacteriana/microbiologia , Endocardite não Infecciosa/etiologia , Feminino , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Desenho de Prótese , Infecções Relacionadas à Prótese/microbiologia , Resultado do TratamentoRESUMO
El conocimiento profundo de las TIC y su impacto sobre la profesión médica, se presenta como algo imprescindible para los radiólogos del siglo XXI. Sólo así serán actores y no meros espectadores de los trascendentales cambios que la radiología y el diagnóstico por la imagen van a experimentar en los próximos años (AU)
The deep knowledge of the TIC and his impact on the medical profession, he appears as something indispensable for the radiologists of the 21st century. Only this way they will be actors and not mere spectators of the transcendental changes that the radiology and the diagnosis for the image are going to experience in the next years (AU)