Diagnostic value of imaging in infective endocarditis: a systematic review.
Lancet Infect Dis. 2017 Jan;17(1):e1-e14
Authors: Gomes A, Glaudemans AW, Touw DJ, van Melle JP, Willems TP, Maass AH, Natour E, Prakken NH, Borra RJ, van Geel PP, Slart RH, van Assen S, Sinha B
Sensitivity and specificity of the modified Duke criteria for native valve endocarditis are both suboptimal, at approximately 80%. Diagnostic accuracy for intracardiac prosthetic material-related infection is even lower. Non-invasive imaging modalities could potentially improve diagnosis of infective endocarditis; however, their diagnostic value is unclear. We did a systematic literature review to critically appraise the evidence for the diagnostic performance of these imaging modalities, according to PRISMA and GRADE criteria. We searched PubMed, Embase, and Cochrane databases. 31 studies were included that presented original data on the performance of electrocardiogram (ECG)-gated multidetector CT angiography (MDCTA), ECG-gated MRI, (18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT, and leucocyte scintigraphy in diagnosis of native valve endocarditis, intracardiac prosthetic material-related infection, and extracardiac foci in adults. We consistently found positive albeit weak evidence for the diagnostic benefit of (18)F-FDG PET/CT and MDCTA. We conclude that additional imaging techniques should be considered if infective endocarditis is suspected. We propose an evidence-based diagnostic work-up for infective endocarditis including these non-invasive techniques.
PMID: 27746163 [PubMed - indexed for MEDLINE]