Methods of diagnosing infective endocarditis including nuclear imaging techniques - a review

Abstract

Introduction and the purpose of work

Infective endocarditis (IE) is a disease diagnosed more and more often in recent years. Its treatment and diagnostics require a team of qualified specialists and are based on microbiological and imaging diagnostics. The purpose of this work is a summary and comparison of individual IE diagnostic methods, including their advantages and disadvantages.

State of knowledge: Diagnosis of infective endocarditis relies on positive blood cultures to identify the microorganism and its drug sensitivity. Advanced methods like MALDI-TOF MS and MIC are used for identification. The first-line imaging diagnostic method for IE is echocardiography, which assesses structural and functional heart damage. Variants include transthoracic (TTE), transesophageal (TOE), three-dimensional TOE, and intracardiac echocardiography. Echocardiography should be performed immediately when IE is suspected. Computed tomography (CT) is crucial for diagnosing infective endocarditis (IE), particularly perivalvular and periprosthetic complications. Whole-body CT, including the brain, detects distant lesions and sources of bacteremia. CT is more accessible in emergencies and effective in spotting ischemic and hemorrhagic complications. CT angiography identifies mycotic aneurysms in the vascular system. It also detects extracardiac sources of bacteremia, aiding treatment and pre-surgery planning. Nuclear imaging is also important in diagnosing IE, especially prosthetic valve endocarditis (PVE) when echocardiography is inconclusive. 18F-fluorodeoxyglucose-PET/CT and SPECT/CT with labeled leukocytes are recommended. 

Conclusions: In addition to basic methods such as positive blood culture and echocardiography, there are more specialized methods that also allow for the assessment of treatment progress and prognosis.