IJCS | Volume 33, Nº1, January / February 2019

DOI: https://doi.org/10.36660/ijcs.20190207 87 REVIEW ARTICLE International Journal of Cardiovascular Sciences. 2020;33(1):87-93 Mailing Address: Domenico Albano ASST Spedali Civili di Brescia - Nuclear Medicine - Piazzale Spedali Civili, 1. Postal Code: 25125 Brescia, Lombardia – Italy E-mail: doalba87@libero.it Molecular Imaging in the Diagnosis of Infectious Endocarditis – the Role of PET and SPECT Domenico Alban o, F rancesco Bertagna , R affaele Giubbin i ASST Spedali Civili di Brescia, Brescia, Lombardia – Italy Manuscript received on November 06, 2019; reviewed on November 06, 2019; accepted on December 09, 2019. Endocarditis,Infectious/ diagnostic imaging; Positron Emission Tomography Computed/methods; Positron Emission Tomography Computed Tomography/ methods; Radiommunodetect/ methods; Leukocytes. Keywords Abstract 18-fluorine-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) and single- photon emission computed tomography (SPECT) using radiolabeled white blood cells (WBC) are non-invasive techniques widely used in the diagnosis of infections, like endocarditis. The aim of our paper was to provide a systematic review of the published data on the use of 18F-FDG PET/CT and SPECT in infective endocarditis (IE). A comprehensive literature search of the PubMed/ MEDLINE, Scopus, Embase and Cochrane library databases was conducted to find relevant published articles about the diagnostic performance of SPECT using WBC and 18F-FDG PET/CT in the diagnosis of infectious endocarditis. Twenty papers were included, with a total of 1,154 patients (166 studies with WBC SPECT and 988 with 18F-FDG PET/CT). From the analyses of the studies, the following results were obtained: both SPECT and PET/CT had good diagnostic accuracy in the study of endocarditis. 18F-FDG PET/CT had good specificity (85.8%) and lower sensitivity (68%), with high heterogeneity among the studies; WBC SPECT/ CT had an overall sensitivity of 80% and specificity of 98%. Specific preparations for PET/CT can affect the diagnostic accuracy of the test. Both 18F-FDG PET/CT and WBC SPECT are useful for the diagnosis of IE, and WBC SPECT appears to be slightly more specific than 18F-FDG PET/CT. A specific diet could influence the diagnostic performance of PET/CT. Introduction Infectious endocarditis (IE) is a serious, potentially life-threatening condition, and a challenge for clinicians due to difficulties in its diagnosis. 1,2 The current diagnostic approach often revolves around the modified Duke criteria, which are composed of a composite of clinical criteria, blood cultures and echocardiographic findings, 3 but cases of uncertain diagnosis are still significant. Cardiac infections include a group of conditions involving the heart muscle, the pericardium or the endocardial surface of the heart. Infections can extend to the prosthetic material or the leads in case of device implantation. The heterogeneity of clinical presentations requires, besides the diagnostic criteria, a discussion by a multidisciplinary team. IE is a representative example where the use of nuclear medicine has evolved as an important diagnostic tool. 4,5 Single photon emission computed tomography (SPECT) using radiolabelled white blood cell (WBC) and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) have been widely used in the diagnosis of infections and in IE, with controversial findings. The aim of this review is to provide a systematic review of published data about the role of WBC SPECT and 18F-FDG PET/CT in the diagnostic work-up of patients with IE. Materials and Methods The present meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta- analyses (PRISMA) statement (see supplementary material for PRISMA Checklist). 6