Added value of 18F-FDG-PET/CT and cardiac CTA in suspected transcatheter aortic valve endocarditis

Figure 1. Distribution of patients with suspected Endocarditis based on Modified Duke Criteria, ESC criteria, and Endocarditis Team consensus based on ESC criteria

Figure 2. Positive results of either TTE/TEE, FDG-PET, and Cardiac CTA in each group with final diagnosis of rejected, possible, and definite TAVI-IE

Figure 3. Two cases of one positive PET/CT and one negative PET/CT for TAVI-IE. Case 1 (A to E): A 75-year-old female with suspected Corevalve TAVI-IE who underwent a TEE without signs of endocarditis (A to C). PET/CT images (D/E) demonstrated focal FDG uptake alongside the corevalve as positive sign of TAVI-IE. This case was previously published as a case report.14 Case 2 (F to I): An 81-year-old female with suspected Edwards-Sapien TAVI-IE who underwent a TEE (F/G) with a vegetation on the aortic valve and mild aortic regurgitation. CTA demonstrated thickening of the aortic valve leaflets (H) as possible signs of vegetation. However, PET/CT images (I) showed no focal 18F-FDG uptake on the leaflets. This was explained by the low inflammatory activity and 2 weeks of intravenous antibiotic therapy prior to the PET/CT scan

Figure 4. CTA images of a 77-year-old male with suspected TAVI-IE. Initial TEE (A, B) showed only thickened aortic valve leaflets as signs of vegetation. Repeating TEE after a few days (C, D) showed a new aortic regurgitation and a paravalvular space as sign of possible mycotic aneurysm, which was confirmed on the CTA (E)

Figure 5. CTA images of a Sapiens valve with signs of leaflet thrombosis (A, C, E) and a Lotus valve with signs of vegetation (B, D, F)