Diagnostic Performance of 18F-FDG PET/CT in Native Valve Endocarditis: Systematic Review and Bivariate Meta-Analysis

Christel H Kamani; Gilles Allenbach; Mario Jreige; Anna G Pavon; Marie Meyer; Nathalie Testart; Maria Firsova; Victor Fernandes Vieira; Sarah Boughdad; Marie Nicod Lalonde; Niklaus Schaefer; Benoit Guery; Pierre Monney; John O Prior; Giorgio Treglia

doi:10.3390/diagnostics10100754

Diagnostic Performance of ¹⁸F-FDG PET/CT in Native Valve Endocarditis: Systematic Review and Bivariate Meta-Analysis

Diagnostics (Basel). 2020 Sep 25;10(10):754. doi: 10.3390/diagnostics10100754.

Authors

Christel H Kamani¹, Gilles Allenbach¹, Mario Jreige¹, Anna G Pavon², Marie Meyer¹, Nathalie Testart¹, Maria Firsova¹, Victor Fernandes Vieira¹, Sarah Boughdad¹, Marie Nicod Lalonde¹, Niklaus Schaefer^{1

3}, Benoit Guery^{3

4}, Pierre Monney^{2

3}, John O Prior^{1

3}, Giorgio Treglia^{1

3

5

6}

Affiliations

¹ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
² Department of Cardiology, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
³ University of Lausanne, CH-1011 Lausanne, Switzerland.
⁴ Department of Infectious Diseases, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
⁵ Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland.
⁶ Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland.

Abstract

Background: Infectious endocarditis is a life-threatening disease, requiring prompt and accurate diagnosis. The aim of this article is to perform a systematic review and meta-analysis of the literature to estimate the performance of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for the diagnosis of native valve endocarditis (NVE).

Methods: Selected articles evaluating the diagnostic accuracy of ¹⁸F-FDG PET/CT in patients with suspected NVE, resulting from a comprehensive literature search through the PubMed/MEDLINE and Cochrane library databases until April 2020, were included for the systematic review and meta-analysis.

Results: Seven studies (351 episodes of suspected NVE) were included. ¹⁸F-FDG PET/CT yielded a pooled sensitivity of 36.3% and a pooled specificity of 99.1% for the diagnosis of NVE. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 8.3, 0.6, and 15.3, respectively. The sensitivity increased using contemporary PET/CT device with state-of-the-art patient preparation as well as innovative image acquisitions or adding the results of ¹⁸F-FDG PET/CT in a multimodality strategy.

Conclusions: In our systematic review and meta-analysis, ¹⁸F-FDG PET/CT yielded a poor pooled sensitivity with an otherwise excellent pooled specificity for the diagnosis of NVE; however, several factors may increase the sensitivity without affecting the specificity and these factors should be better evaluated in future studies.

Keywords: 18F-FDG; PET/CT; diagnostic performance; infectious diseases; infectious endocarditis; meta-analysis; native valve endocarditis; positron emission tomography; systematic review..