{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:11:20Z","timestamp":1790115080801,"version":"4.0.1"},"reference-count":48,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Infective endocarditis (IE) as a diagnosis remains challenging, particularly in prosthetic valve endocarditis (PVE). This study evaluates the diagnostic utility of 18F-fluorodeoxyglucose positron emission tomography\/computed tomography (18F-FDG PET\/CT) in patients with suspected IE. Seventy patients with suspected IE underwent clinical, microbiological, echocardiographic, and 18F-FDG PET\/CT evaluation. Diagnostic performance of PET\/CT was assessed against clinical classification based on modified Duke criteria. Definitive PVE was diagnosed in 18 patients (26%), while 52 (74%) had possible IE. PET\/CT reclassified 13 patients from possible to definite IE, demonstrating an overall sensitivity of 83.3%, specificity of 93.7%, positive predictive value (PPV) of 83.3%, and negative predictive value (NPV) of 93.7%. Excluding native valve endocarditis cases, sensitivity and specificity increased to 94.1% and 95.7%, respectively. PET\/CT detected septic emboli in five patients and incidental malignancies in three cases, underscoring its role in comprehensive patient evaluation. False-negative results were mostly observed in early post-surgical PVE and native valve endocarditis. PET\/CT also identified alternative diagnoses in patients reclassified as rejected IE. 18F-FDG PET\/CT provides high diagnostic accuracy for suspected PVE, significantly aiding reclassification of ambiguous cases and detection of extracardiac complications and malignancies. Its integration into diagnostic algorithms may improve clinical management and outcomes in complex IE cases.<\/jats:p>","DOI":"10.3390\/microorganisms13061299","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T03:57:18Z","timestamp":1748923038000},"page":"1299","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Diagnostic Utility of 18F-FDG PET\/CT in Infective Endocarditis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8818-9539","authenticated-orcid":false,"given":"Corina-Ioana","family":"Anton","sequence":"first","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania"},{"name":"Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania"},{"name":"Department of Infectious Diseases, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice-Elena","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania"},{"name":"Department of Cardiology, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 010825 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5398-3210","authenticated-orcid":false,"given":"Mihaela Raluca","family":"Mititelu","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania"},{"name":"Department of Nuclear Medicine, University Emergency Central Military Hospital, 010825 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Militaru","family":"Alexandru \u0218tefan","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Emergency Central Military Hospital, 010825 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4289-178X","authenticated-orcid":false,"given":"Cosmin-Alexandru","family":"Buzil\u0103","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Streinu-Cercel","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u015f\u201d, 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s00392-021-01975-z","article-title":"Diagnostic value of 18F-FDG PET\/CT in infective endocarditis","volume":"111","author":"Cannata","year":"2022","journal-title":"Clin. Res. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s43055-022-00914-w","article-title":"Unexpected septic pulmonary embolism imaging with 18F-FDG PET\/CT in an infective endocarditis case: Case report","volume":"53","author":"Akgun","year":"2022","journal-title":"Egypt. J. Radiol. Nucl. Med."},{"key":"ref_3","unstructured":"Krajinovic, K., Lauc, G., and Kralik, S. (2022). Dual-Time-Point 18F-FDG PET\/CT in Infective Endocarditis: Impact of delayed imaging in the definitive diagnosis of endocarditis. Biomedicines, 12."},{"key":"ref_4","first-page":"203","article-title":"The role of 18F-FDG-PET\/CT in infectious endocarditis and cardiac device infection","volume":"3","author":"Rewers","year":"2022","journal-title":"Curr. Mol. Imaging"},{"key":"ref_5","first-page":"1305","article-title":"18F-FDG PET\/CT in infective endocarditis: Indications and approaches for standardization","volume":"24","year":"2022","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_6","first-page":"1617","article-title":"The role of 18F-FDG PET\/CT in the evaluation of infective endocarditis","volume":"28","author":"Basu","year":"2021","journal-title":"J. Nucl. Cardiol."},{"key":"ref_7","first-page":"1052","article-title":"Diagnostic performance of 18F-FDG PET\/CT in prosthetic valve endocarditis: A systematic review and meta-analysis","volume":"48","author":"Chong","year":"2021","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_8","first-page":"1078","article-title":"Utility of 18F-FDG PET\/CT in the diagnosis of infective endocarditis: A meta-analysis","volume":"75","author":"Feldman","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","first-page":"678","article-title":"Role of 18F-FDG PET\/CT in the assessment of cardiac device infections","volume":"62","year":"2021","journal-title":"J. Nucl. Med."},{"key":"ref_10","first-page":"345","article-title":"Diagnostic accuracy of 18F-FDG PET\/CT in infective endocarditis: A systematic review and meta-analysis","volume":"81","author":"Huang","year":"2020","journal-title":"J. Infect."},{"key":"ref_11","first-page":"345","article-title":"The role of 18F-FDG PET\/CT in the diagnosis and management of infective endocarditis","volume":"51","author":"Ibrahim","year":"2021","journal-title":"Semin. Nucl. Med."},{"key":"ref_12","first-page":"4001","article-title":"Clinical impact of 18F-FDG PET\/CT in patients with suspected infective endocarditis","volume":"9","author":"Jang","year":"2020","journal-title":"J. Clin. Med."},{"key":"ref_13","first-page":"749","article-title":"The diagnostic value of 18F-FDG PET\/CT in native valve endocarditis: A systematic review and meta-analysis","volume":"22","author":"Kim","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_14","first-page":"32","article-title":"Role of 18F-FDG PET\/CT in the diagnosis of infective endocarditis: A review","volume":"10","author":"Lee","year":"2020","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_15","unstructured":"Li, X., and Liu, Y. (2021). Diagnostic performance of 18F-FDG PET\/CT in prosthetic valve endocarditis: A meta-analysis. Front. Cardiovasc. Med., 8."},{"key":"ref_16","first-page":"2780","article-title":"The role of 18F-FDG PET\/CT in the diagnosis of infective endocarditis: A systematic review and meta-analysis","volume":"47","author":"Liu","year":"2020","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_17","first-page":"1611","article-title":"The diagnostic value of 18F-FDG PET\/CT in cardiac device infections: A systematic review and meta-analysis","volume":"37","author":"Luo","year":"2021","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_18","first-page":"1018","article-title":"Infective endocarditis in adults: A review","volume":"324","author":"Mylonakis","year":"2020","journal-title":"JAMA"},{"key":"ref_19","first-page":"456","article-title":"Utility of 18F-FDG PET\/CT in the diagnosis of infective endocarditis: A retrospective study","volume":"35","author":"Nakamura","year":"2021","journal-title":"Ann. Nucl. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3093","DOI":"10.1007\/s12350-020-02223-z","article-title":"18F-FDG PET\/CT in the diagnosis of cardiac device-related infective endocarditis","volume":"28","author":"Freitas","year":"2021","journal-title":"J. Nucl. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2188","DOI":"10.1007\/s12350-021-02663-1","article-title":"New criteria for the diagnosis of infective endocarditis using 18F-FDG PET\/CT imaging","volume":"29","author":"Gazzilli","year":"2022","journal-title":"J. Nucl. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e008956","DOI":"10.1161\/CIRCIMAGING.120.008956","article-title":"Cardiovascular imaging in infective endocarditis: A multimodality approach","volume":"13","author":"Horgan","year":"2020","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_23","first-page":"135","article-title":"18F-FDG PET\/CT in the diagnosis of prosthetic valve endocarditis: A review","volume":"13","author":"Yedur","year":"2021","journal-title":"World J. Cardiol."},{"key":"ref_24","first-page":"121","article-title":"18F-FDG PET\/CT in patients with suspected prosthetic valve endocarditis: A diagnostic aid","volume":"49","author":"Avesani","year":"2021","journal-title":"J. Nucl. Med. Technol."},{"key":"ref_25","first-page":"1125","article-title":"Clinical role of 18F-FDG PET\/CT in the early detection of infective endocarditis","volume":"18","author":"Gupta","year":"2021","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_26","first-page":"3499","article-title":"Utility of 18F-FDG PET\/CT in detecting infective endocarditis: Meta-analysis and systematic review","volume":"32","author":"Zhang","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_27","first-page":"635","article-title":"Role of imaging, including 18F-FDG PET\/CT in diagnosing infective endocarditis: A retrospective study","volume":"50","author":"Behzadi","year":"2021","journal-title":"Heart Lung"},{"key":"ref_28","first-page":"898","article-title":"Comparative diagnostic performance of 18F-FDG PET\/CT and echocardiography in infective endocarditis","volume":"49","author":"Elbanhawy","year":"2022","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_29","first-page":"26","article-title":"Evaluation of myocardial inflammation in infective endocarditis using FDG PET imaging","volume":"49","author":"Hirayama","year":"2022","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_30","first-page":"1054","article-title":"18F-FDG PET\/CT for diagnosis of infective endocarditis: From bacterial detection to treatment planning","volume":"222","author":"Sugiura","year":"2020","journal-title":"J. Infect. Dis."},{"key":"ref_31","first-page":"130","article-title":"The role of 18F-FDG PET\/CT in detecting infective endocarditis of the heart valves","volume":"10","author":"Takahashi","year":"2020","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_32","first-page":"276","article-title":"Evaluation of infective endocarditis using 18F-FDG PET\/CT: A systematic review of the literature","volume":"23","author":"Li","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_33","first-page":"1024","article-title":"The role of hybrid imaging with 18F-FDG PET\/CT in the diagnosis and management of infective endocarditis: A review","volume":"63","author":"Eperjesi","year":"2022","journal-title":"J. Nucl. Med."},{"key":"ref_34","first-page":"429","article-title":"Diagnostic value of 18F-FDG PET\/CT for identifying aortic valve infective endocarditis","volume":"77","author":"Abela","year":"2021","journal-title":"J. Cardiol."},{"key":"ref_35","first-page":"23","article-title":"The role of 18F-FDG PET\/CT imaging in diagnosing endocarditis: A comprehensive review of clinical studies","volume":"7","author":"Vogt","year":"2022","journal-title":"Cardiovasc. Imaging"},{"key":"ref_36","first-page":"376","article-title":"Diagnostic accuracy of 18F-FDG PET\/CT for diagnosing infective endocarditis: A prospective study","volume":"78","author":"Ogura","year":"2021","journal-title":"J. Cardiol."},{"key":"ref_37","first-page":"652","article-title":"Combined approach of 18F-FDG PET\/CT and transthoracic echocardiography in suspected prosthetic valve endocarditis","volume":"108","author":"Lee","year":"2022","journal-title":"Heart"},{"key":"ref_38","first-page":"953","article-title":"Imaging techniques for the diagnosis of infective endocarditis: The role of 18F-FDG PET\/CT","volume":"35","author":"Sasaki","year":"2020","journal-title":"Heart Vessels"},{"key":"ref_39","first-page":"96","article-title":"The diagnostic role of 18F-FDG PET\/CT in suspected cases of infective endocarditis: A systematic review of the literature","volume":"15","author":"Caruso","year":"2021","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_40","first-page":"421","article-title":"PET\/CT in infective endocarditis: An emerging imaging modality for clinical management","volume":"45","author":"Osipova","year":"2020","journal-title":"Clin. Nucl. Med."},{"key":"ref_41","first-page":"1945","article-title":"Comparative evaluation of 18F-FDG PET\/CT versus echocardiography in the diagnosis of infective endocarditis","volume":"42","author":"Dijkhuizen","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_42","first-page":"409","article-title":"The diagnostic performance of 18F-FDG PET\/CT in infective endocarditis and its impact on management decisions: A systematic review","volume":"41","author":"Zhang","year":"2020","journal-title":"Nucl. Med. Commun."},{"key":"ref_43","first-page":"276","article-title":"Imaging techniques in the diagnosis of infective endocarditis: The emerging role of 18F-FDG PET\/CT","volume":"28","author":"Prat","year":"2022","journal-title":"J. Cardiovasc. Imaging"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1093\/ehjci\/jead175","article-title":"The power of negative metabolic imaging: Negative FDG-PET\/CT predicts infective endocard","volume":"24","author":"Lancellotti","year":"2023","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_45","first-page":"556","article-title":"Clinical implications of 18F-FDG PET\/CT in prosthetic valve endocarditis: A prospective study","volume":"45","author":"Mukherjee","year":"2022","journal-title":"Clin. Cardiol."},{"key":"ref_46","first-page":"1270","article-title":"Utility of 18F-FDG PET\/CT in cardiac implantable electronic device infections: A meta-analysis","volume":"22","author":"Patel","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_47","first-page":"881","article-title":"Diagnostic challenges and solutions in infective endocarditis: Role of 18F-FDG PET\/CT","volume":"36","author":"Tanaka","year":"2022","journal-title":"Ann. Nucl. Med."},{"key":"ref_48","first-page":"12","article-title":"Advances in PET\/CT imaging in infective endocarditis: Current status and future perspectives","volume":"64","author":"Yamamoto","year":"2023","journal-title":"J. Nucl. Med."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/6\/1299\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:46:23Z","timestamp":1760031983000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/6\/1299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":48,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["microorganisms13061299"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13061299","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,3]]}}}