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Review
. 2023 Dec 28;14(1):54.
doi: 10.3390/life14010054.

Multimodality Imaging Diagnosis in Infective Endocarditis

Elena Emilia Babes  1   2 , Cristiana Bustea  3 , Tiberia Ioana Ilias  2 , Victor Vlad Babes  2 , Silvia-Ana Luca  4   5   6 , Constantin Tudor Luca  4   5   6 , Andrei-Flavius Radu  1   3 , Alexandra Georgiana Tarce  7 , Alexa Florina Bungau  1   3 , Cristian Bustea  8
Affiliations
Review

Multimodality Imaging Diagnosis in Infective Endocarditis

Elena Emilia Babes et al. Life (Basel). .

Abstract

Imaging is an important tool in the diagnosis and management of infective endocarditis (IE). Echocardiography is an essential examination, especially in native valve endocarditis (NVE), but its diagnostic accuracy is reduced in prosthetic valve endocarditis (PVE). The diagnostic ability is superior for transoesophageal echocardiography (TEE), but a negative test cannot exclude PVE. Both transthoracic echocardiography (TTE) and TEE can provide normal or inconclusive findings in up to 30% of cases, especially in patients with prosthetic devices. New advanced non-invasive imaging tests are increasingly used in the diagnosis of IE. Nuclear medicine imaging techniques have demonstrated their superiority over TEE for the diagnosis of PVE and cardiac implantable electronic device infective endocarditis (CIED-IE). Cardiac computed tomography angiography imaging is useful in PVE cases with inconclusive TTE and TEE investigations and for the evaluation of paravalvular complications. In the present review, imaging tools are described with their values and limitations for improving diagnosis in NVE, PVE and CIED-IE. Current knowledge about multimodality imaging approaches in IE and imaging methods to assess the local and distant complications of IE is also reviewed. Furthermore, a potential diagnostic work-up for different clinical scenarios is described. However, further studies are essential for refining diagnostic and management approaches in infective endocarditis, addressing limitations and optimizing advanced imaging techniques across different clinical scenarios.

Keywords: 18-fluorodeoxyglucose PET/CT; cardiac CT; cardiac implantable electronic device infection; echocardiography; infective endocarditis; native valve endocarditis; prosthetic valve endocarditis; radiolabelled WBC.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart describing literature selection.
Figure 2
Figure 2
Imagistic diagnostic approach in patients with suspected NVE. NVE, native valve endocarditis; TTE, transthoracic echocardiography; TEE, transesophageal echocardiography; MDCT, multidetector computed tomography; FDG-PET/CT, 18-fluorodeoxyglucose positron emission tomography/computed tomography.
Figure 3
Figure 3
Imagistic diagnostic approach in patients with suspected PVE. PVE, prosthetic valve endocarditis; TTE, transthoracic echocardiography; TEE, transesophageal echocardiography; MDCTA, multidetector computed tomography; FDG-PET/CT, 18-fluorodeoxyglucose positron emission tomography/computed tomography; WBC SPECT/CT, white-blood-cell single-photon emission tomography combined with computed tomography.
Figure 4
Figure 4
Imagistic diagnostic approach in patients with suspected CIED-related infection. CIED, cardiac implantable electronic device; TTE, transthoracic echocardiography; TEE, transesophageal echocardiography; 3D, three-dimensional; FDG-PET/CT, 18-fluorodeoxyglucose positron emission tomography/computed tomography.
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