Clinical utility of 18F-FDG positron emission tomography/computed tomography scan vs. 99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis

Trine K Lauridsen; Kasper K Iversen; Nikolaj Ihlemann; Philip Hasbak; Annika Loft; Anne K Berthelsen; Anders Dahl; Danijela Dejanovic; Elisabeth Albrecht-Beste; Jann Mortensen; Andreas Kjær; Henning Bundgaard; Niels Eske Bruun

doi:10.1007/s10554-016-1047-1

Clinical utility of ¹⁸F-FDG positron emission tomography/computed tomography scan vs. ^99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis

Trine K Lauridsen, Kasper K Iversen, Nikolaj Ihlemann, Philip Hasbak, Annika Loft, Anne K Berthelsen, Anders Dahl, Danijela Dejanovic, Elisabeth Albrecht-Beste, Jann Mortensen, Andreas Kjær, Henning Bundgaard, Niels Eske Bruun

16 Citations (Scopus)

Abstract

The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether18FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49-0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61-0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.

Original language	English
Journal	International Journal of Cardiovascular Imaging
Volume	33
Issue number	5
Pages (from-to)	751-760
ISSN	1569-5794
DOIs	https://doi.org/10.1007/s10554-016-1047-1
Publication status	Published - 1 May 2017

Keywords

Aged
Endocarditis/blood
Female
Fluorodeoxyglucose F18/administration & dosage
Humans
Leukocytes
Male
Middle Aged
Observer Variation
Positron Emission Tomography Computed Tomography
Predictive Value of Tests
Radiopharmaceuticals/administration & dosage
Reproducibility of Results
Single Photon Emission Computed Tomography Computed Tomography
Technetium Tc 99m Exametazime/administration & dosage

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Lauridsen, T. K., Iversen, K. K., Ihlemann, N., Hasbak, P., Loft, A., Berthelsen, A. K., Dahl, A., Dejanovic, D., Albrecht-Beste, E., Mortensen, J., Kjær, A., Bundgaard, H., & Bruun, N. E. (2017). Clinical utility of ¹⁸F-FDG positron emission tomography/computed tomography scan vs. ^99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis. International Journal of Cardiovascular Imaging, 33(5), 751-760. https://doi.org/10.1007/s10554-016-1047-1

Clinical utility of ¹⁸F-FDG positron emission tomography/computed tomography scan vs. ^99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis. / Lauridsen, Trine K; Iversen, Kasper K; Ihlemann, Nikolaj et al.
In: International Journal of Cardiovascular Imaging, Vol. 33, No. 5, 01.05.2017, p. 751-760.

Research output: Contribution to journal › Journal article › Research › peer-review

Lauridsen, TK, Iversen, KK, Ihlemann, N, Hasbak, P, Loft, A, Berthelsen, AK, Dahl, A, Dejanovic, D, Albrecht-Beste, E , Mortensen, J , Kjær, A , Bundgaard, H & Bruun, NE 2017, 'Clinical utility of ¹⁸F-FDG positron emission tomography/computed tomography scan vs. ^99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis', International Journal of Cardiovascular Imaging, vol. 33, no. 5, pp. 751-760. https://doi.org/10.1007/s10554-016-1047-1

Lauridsen TK, Iversen KK, Ihlemann N, Hasbak P, Loft A, Berthelsen AK et al. Clinical utility of ¹⁸F-FDG positron emission tomography/computed tomography scan vs. ^99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis. International Journal of Cardiovascular Imaging. 2017 May 1;33(5):751-760. doi: 10.1007/s10554-016-1047-1

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title = "Clinical utility of 18F-FDG positron emission tomography/computed tomography scan vs. 99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis",

abstract = "The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether18FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49-0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61-0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.",

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AU - Lauridsen, Trine K

AU - Iversen, Kasper K

AU - Ihlemann, Nikolaj

AU - Hasbak, Philip

AU - Loft, Annika

AU - Berthelsen, Anne K

AU - Dahl, Anders

AU - Dejanovic, Danijela

AU - Albrecht-Beste, Elisabeth

AU - Mortensen, Jann

AU - Kjær, Andreas

AU - Bundgaard, Henning

AU - Bruun, Niels Eske

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N2 - The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether18FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49-0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61-0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.

AB - The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether18FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49-0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61-0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.

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KW - Observer Variation

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KW - Reproducibility of Results

KW - Single Photon Emission Computed Tomography Computed Tomography

KW - Technetium Tc 99m Exametazime/administration & dosage

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