Abstract 16209: Performance of Multislice CT and Added Value of 18FDG-PET/ CT Image Fusion in Detecting Prosthetic Valve Dysfunction and Infection: Comparative Study With Echocardiography and Surgery
Objectives: to evaluate cardiac CT and 18FDG-PET/CT image fusion in the diagnostic work-up of prosthetic valve dysfunction/infection, in comparison with transesophageal echocardiography (TEE) and surgery.
Methods: A total of 33 patients (age, 61 years) with 36 prosthesis (22 mechanic, 8 bioprosthetic, 4 pulmhomografts, 2 annuloplasty) were examined with ECG-gated 64-slice or 128-slice dual source CT coronary angiography. All pts underwent TEE. Surgery was performed in 15pts. 18FDG-PET was performed in case of suspected infection but equivocal clinical and imaging findings.
Results:. There were 40 prosthetic abnormalies (8 paravalvular leaks, 5 dehiscence, 5 pseudoaneurysm, 7 abscess, 2 bioprosthetic SVD, 5 aortic regurgitations, 1 mitral stenosis; 6 masses [1 thrombus, 4 vegetations, 1 degenerative mass], 1 ruptured chordae) and 1 occluded RCA ostium. The sens. of CT vs surgery on a per lesion based analysis was 94% (3 FP and 2 FN) (95% CI:82–98), and the sens. of echo vs surgery was 76.9% (9 FN and 1FP) (95% CI:62–87), common FN were dehiscence. 10pts had evident clinical signs of infection (=definite diagnosis of IE/Duke-crit.), and 2 pts had uncertain signs: slight CRP elevation, negative bloodculture, normal WBC and equivocal TEE & CT imaging findings, therefore 18FDG-PET was appended. 18FDG-PET/CT image fusion corrected detected 1 active paravalvular abscess (see Fig.), 1 bioprosthetic valve anterior leaflet infection, and correctly diagnosed 1 non-active “healed” leak and 1 thrombus, as compared to surgery/histopathology (sens.,100%) which improved the sens. of CT.
Conclusion: Cardiac CT is a valuable tool in the work-up of suspected prosthetic valve dysfunction, in particular for paravalvular involvement. 18FDG-PET/CT image fusion has added value to detect active inflammation in case of suspected infection but controversy clinical and imaging (TEE/CT) findings. CT (left) and PET/CT (right) image fusion: annulus abscess and superimposed thrombus
- © 2010 by American Heart Association, Inc.