Diagnostic value of SPECT for endocarditis: a systematic review and meta-analysis

Abstract

Aim: Early identification of infective endocarditis (IE) and proper treatment can limit mortality and complications. The ability of scintigraphy in locating acute inflammatory lesions can be useful in improving diagnostic efficiency. This systematic review and meta-analysis assessed the diagnostic performance of SPECT in patients with IE.

Materials and methods: The analysis was performed in accordance with PRISMA and QUADAS-2 criteria and included articles from Medline, Embase, and Cochrane databases. A total of 1099 records were identified, published until 2024. Of these, 25 studies were included in the systematic review, and 21 studies were included in the meta-analysis.

Results: Summary estimates for SPECT show high diagnostic accuracy for detecting IE, with a sensitivity of 75.8% and specificity of 87.4%, as well as excellent overall accuracy (AUROC = 0.816). A higher sensitivity and specificity, 82.9% and 91.4% respectively, were observed for cardiac device related endocarditis (CDRE) diagnosis using 99mTc-HMPAO-WBC SPECT.

Conclusion: This meta-analysis demonstrates that scintigraphy exhibits high diagnostic accuracy in detecting IE, and may be especially valuable in diagnosing CDRE, especially in cases where traditional imaging modalities are inconclusive. Nonetheless, multicenter studies are needed to establish the role of SPECT within the broader diagnostic framework for IE.