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. 2020 Sep 25;10(10):754.
doi: 10.3390/diagnostics10100754.

Diagnostic Performance of 18F-FDG PET/CT in Native Valve Endocarditis: Systematic Review and Bivariate Meta-Analysis

Christel H Kamani  1 , Gilles Allenbach  1 , Mario Jreige  1 , Anna G Pavon  2 , Marie Meyer  1 , Nathalie Testart  1 , Maria Firsova  1 , Victor Fernandes Vieira  1 , Sarah Boughdad  1 , Marie Nicod Lalonde  1 , Niklaus Schaefer  1   3 , Benoit Guery  3   4 , Pierre Monney  2   3 , John O Prior  1   3 , Giorgio Treglia  1   3   5   6
Affiliations

Diagnostic Performance of 18F-FDG PET/CT in Native Valve Endocarditis: Systematic Review and Bivariate Meta-Analysis

Christel H Kamani et al. Diagnostics (Basel). .

Abstract

Background: Infectious endocarditis is a life-threatening disease, requiring prompt and accurate diagnosis. The aim of this article is to perform a systematic review and meta-analysis of the literature to estimate the performance of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for the diagnosis of native valve endocarditis (NVE).

Methods: Selected articles evaluating the diagnostic accuracy of 18F-FDG PET/CT in patients with suspected NVE, resulting from a comprehensive literature search through the PubMed/MEDLINE and Cochrane library databases until April 2020, were included for the systematic review and meta-analysis.

Results: Seven studies (351 episodes of suspected NVE) were included. 18F-FDG PET/CT yielded a pooled sensitivity of 36.3% and a pooled specificity of 99.1% for the diagnosis of NVE. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 8.3, 0.6, and 15.3, respectively. The sensitivity increased using contemporary PET/CT device with state-of-the-art patient preparation as well as innovative image acquisitions or adding the results of 18F-FDG PET/CT in a multimodality strategy.

Conclusions: In our systematic review and meta-analysis, 18F-FDG PET/CT yielded a poor pooled sensitivity with an otherwise excellent pooled specificity for the diagnosis of NVE; however, several factors may increase the sensitivity without affecting the specificity and these factors should be better evaluated in future studies.

Keywords: 18F-FDG; PET/CT; diagnostic performance; infectious diseases; infectious endocarditis; meta-analysis; native valve endocarditis; positron emission tomography; systematic review..

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study selection and search results.
Figure 2
Figure 2
Overall quality assessment of the studies included in the systematic review according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.
Figure 3
Figure 3
Forest plot of individual studies and pooled positive likelihood ratio of 18F-FDG PET/CT in patients with suspicious native valve endocarditis (NVE), including 95% confidence interval (95% CI). The size of the squares indicates the weight of each study. The blue rhombus indicates the pooled estimate with 95% confidence intervals.
Figure 4
Figure 4
Forest plot of individual studies and pooled negative likelihood ratio of 18F-FDG PET/CT in patients with suspicious NVE, including 95% confidence interval (95%CI). The size of the squares indicates the weight of each study. The blue rhombus indicates the pooled estimate with 95% confidence intervals.
Figure 5
Figure 5
Forest plot of individual studies and pooled diagnostic odds ratio of 18F-FDG PET/CT in patients with suspicious NVE, including 95% confidence interval (95%CI). The size of the squares indicates the weight of each study. The blue rhombus indicates the pooled estimate with 95% confidence intervals.
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