Characterization of 18 F-Fluorodeoxyglucose Uptake Pattern in Noninfected Prosthetic Heart Valves

Author:

Mathieu Cédric1,Mikaïl Nidaa1,Benali Khadija1,Iung Bernard1,Duval Xavier1,Nataf Patrick1,Jondeau Guillaume1,Hyafil Fabien1,Le Guludec Dominique1,Rouzet François1

Affiliation:

1. From the Department of Nuclear Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (APHP) and DHU FIRE, France (C.M., N.M., K.B., F.H., D.L.G., F.R.); Paris-Diderot University, France (N.M., K.B., B.I., X.D., P.N., G.J., F.H., D.L.G., F.R.); Inserm Unité Mixte de Recherche U1148, LVTS (N.M., K.B., B.I., P.N., G.J., F.H., D.L.G., F.R.); Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, France (B.I., G.J.); Inserm Clinical Investigation...

Abstract

Background— 18 F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been recently acknowledged as a diagnostic tool for prosthetic valve endocarditis, but its specificity is limited by uptake on noninfected valves. The objective of this study was to outline the main features of FDG uptake on PET/CT in patients with noninfected prosthetic heart valve (PHV). Methods and Results— Our institution’s PET/CT database was reviewed to identify patients with PHV, excluding those suspected of infection or who had received antibiotic treatment. PET indication, valve location, and type (biological/mechanical) and time from implantation were collected for each patient. Images with and without attenuation correction were considered for interpretation. The pattern of FDG uptake (absent, homogeneous, or heterogeneous) was recorded. Fifty-four PHVs (51 patients) were identified, including 32 biological valves. Indications for PET were oncology (n=26), suspicion of prosthetic valve endocarditis subsequently excluded (n=17), and history of vasculitis (n=11). A periprosthetic FDG uptake was present in 47 (87%) and 30 (56%) PHVs with and without attenuation correction, respectively, and the pattern was homogeneous in all but 4 (7%) and 3 (6%) PHVs, respectively. On quantitative analysis, maximum standardized uptake values was greater in mechanical than in biological valves (4.0 [2.4–8.0] versus 3.3 [2.1–6.1]; P =0.01) and in patients with vasculitis than in those referred for other indications. The uptake intensity did not differ before and 3 months after valve replacement. Conclusions— Noninfected PHVs frequently display homogeneous FDG uptake, which remains steady over time. Caution is, therefore, needed when interpreting FDG PET/CT in suspected prosthetic valve endocarditis, with specific attention to uptake pattern.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging

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