Key result
PET SUVmax cutoffs for prosthetic valve endocarditis vary widely across centers, precluding interchangeable use.
Why the study?
The significance and threshold values for standardized uptake value (SUV) in FDG PET/CT to diagnose prosthetic heart valve endocarditis (PVE) are unclear and lack standardization.
Systematic Review (n=330)
Site-specific SUVmax thresholds may be needed for prosthetic valve endocarditis diagnosis; leaves open the need for standardized protocols and local validation.
BACKGROUND: The significance of and threshold values for the standardized uptake value (SUV) in FDG PET/CT to diagnose prosthetic heart valve (PHV) endocarditis (PVE) are unclear at present. METHODS: A literature search was performed in the PubMed and EMBASE medical databases, comprising the following terms: (FDG OR *fluorode* OR *fluoro-de*) AND (endocarditis OR prosthetic heart valve OR valve replacement). Studies reporting SUVs correlated to the diagnosis of PVE were selected for analysis. RESULTS: 8 studies were included, with a total of 330 PHVs assessed. SUVs for PVE varied substantially across studies due to differences in acquisition, reconstruction, and measurement protocols, with median SUVmax values for rejected PVE ranging from 0.5 to 4.9 and for definite PVE ranging from 4.2 to 7.4. CONCLUSION: Reported SUV values for PVE are not interchangeable between sites, and further standardization of quantification is desirable. To this end, optimal protocols for patient preparation, image acquisition, and reconstruction and measurement methods need to be standardized across centers.
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Scholtens et al. (2017) conducted a systematic review in Prosthetic heart valve endocarditis (PVE) (n=330). FDG PET/CT vs. Rejected PVE was evaluated on Standardized uptake value (SUVmax). Reported median SUVmax values for diagnosing definite prosthetic heart valve endocarditis varied substantially across studies (ranging from 4.2 to 7.4), demonstrating that values are not interchangeable between sites.
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