Review ArticlesMeta‐analysis assessing the sensitivity and specificity of 18F‐FDG PET/CT for the diagnosis of prosthetic valve endocarditis (PVE) using individual patient data (IPD)
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Section snippets
Methods
This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis of Individual Participant Data (PRISMA-IPD).13 The initial research protocol was registered with PROSPERO (CRD42020148707).
Results
Seventeen studies were included (Figure 1), their characteristics are described in Table I. IPD was available for 537 patients (from 538 scans). Patient characteristics are summarised in Table II. In 7 of the 17 studies a final diagnosis of “possible PVE” was a potential diagnosis. Across all studies, there were 47 “possible PVE,” 299 “definite PVE,” and 192 “rejected PVE” diagnoses. Table III also outlines the difference between the patients’ preliminary Duke classification and their final
Discussion
In addition to confirming that 18F-FDG PET/CT has a high sensitivity and specificity in diagnosing PVE, this IPD meta-analysis identifies factors which may affect the accuracy of the test. Patients with a known pathogen; elevated CRP; a biological or aortic valve infection appeared more likely to receive an accurate PET result whereas patients with a mechanical valve; prior antibiotic treatment or a TAVR valve appeared less likely to have an accurate test result. Pertinent clinical factors of
Conclusions
18F-FDG PET/CT has a high sensitivity and specificity in diagnosing PVE and the diagnostic utility is greatest in patients with a preliminary Duke classification of “possible PVE” as most of these patients received a more definitive classification of “definite” or “rejected” PVE following the PET study. This study shows this accuracy does not appear to be affected in the early post-operative period or in the presence of surgical adhesive. The diagnostic accuracy may be higher in patients with
Conflict of interest
None reported.
Funding
No extramural funding was used to support this work.
The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting, and editing of the paper and its final contents.
Acknowledgments
We acknowledge the assistance of the following in the interpretation or contribution of data:
Dr Igor Fomin, Dr Raphael Abegão de Camargo, Dr Asbjorn Schøltens, Dr Diana Pursanova and Dr Ulla Hohenthal.
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