Cardiac CT, FDG-PET and Cardiac MRI in infective endocarditis
Juan C. Lopez-Mattei, M.D., FACC, FASE, FSCCT, FSCMR
Associate Professor of Medicine and Radiology
Co-Director of MD Anderson Cardiac Radiology Services
Objectives
• Understand the diagnostic value of other techniques in the diagnosis of infective endocarditis (IE)
• Understand strengths and limitation of each technique for Dx of IE
• Being able to apply the appropriate technique to the appropriate clinical indication (prosthetic valve vs. native valve).
Why other modalities in IE?
• Pandemic of COVID 19
• Highly contagious disease and diminish staff exposure
• Donning and doffing are common methods of contamination
• Limited PPE availability
• Spectrum of strength in indications
• Some cases are just not clarified by echo
VEG score and NPV for exclusion of IE with TTE
Connolly, et al. J Am Soc Echocardiogr 2019;32:1551-7
CCT performs well in identifying abscess
International Journal of Cardiovascular Imaging (2018) 34:1155–1163
Putting it all together….
Suspected endocarditis with native valve
Suspected endocarditis with prosthetic valve
PUI or COVID+ COVID –ve or low risk for COVID
1. Consider clarity/Quality of TTE (VEG score)
2. Cardiac CT3. TEE with full PPE and minimal
ancillary staff
1. Consider clarity/Quality of TTE (VEG score)
2. TEE with full PPE
PUI or COVID+ COVID –ve or low risk for COVID
1. Quality of TTE2. PET FDG / Cardiac CT3. TEE with full PPE and minimal ancillary staff
1. Quality of TTE2. TEE with full PPE
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