Characteristic imaging features of infective endocarditis on multimodality imaging.
| Finding | Echocardiography (TTE/TEE) | Cardiac PET | Cardiac CT | Sensitivity | Specificity |
|---|---|---|---|---|---|
| Vegetation | Mobile echodense mass attached to valve or device; best seen on TEE | Focal increased 18F-FDG uptake on valve leaflets or prosthetic components | May be seen as low-attenuation mass on valve, but limited sensitivity | TTE: 50–70%TEE: 90–100%PET: 30–40% (native), 73–100% (PVE)CT: 60–90% | TTE: 90–95%TEE: 90–100%PET: 80–100%CT: 88–95% |
| Abscess | Echolucent or echodense periannular area; better seen on TEE | Perivalvular fluid collection with intense 18F-FDG uptake | Periannular low-attenuation area; ring enhancement | TTE: 25–40%TEE: ~80–90%PET: 80–87%CT: 90–95% | TTE: 90–95%TEE: 90%PET: 83–95%CT: 95% |
| Pseudoaneurysm | Pulsatile echo-free space adjacent to annulus, with systolic expansion | Outpouching adjacent to valve annulus on that may or may not exhibit 18F-FDG uptake | Contrast-filled outpouching with communication with cardiac chamber | TTE: 20–40%TEE: 85–98%PET: 60–80%CT: 95% | TTE: 90–95%TEE: 90–100%PET: 90–100%CT: 90–100% |
| Leaflet perforation | Color Doppler shows flow through perforation; direct visualization on TEE | Not directly seen on PETMay show secondary signs like vegetation or uptake in perforated area | May see small discontinuity; less sensitive | TTE: 25–50%TEE: 80–90%PET: poor detectionCT: 30–60% | TTE: 90–95%TEE: 90–100%PET: poor detectionCT: 100% |
| Fistula | Abnormal color Doppler jet between chambers (e.g., LV-RA); best on TEE | Linear 18F-FDG uptake along tract if inflammation present | Direct tract visualization with contrast; better delineation of anatomy | TTE: 30–50%TEE: 85–95%PET: limitedCT: ~90% | TTE: 90–95%TEE: 95%PET: limitedCT: ~95% |
| Paravalvular leak | Color Doppler shows turbulent flow around sewing ring; TEE is key | Low or no 18F-FDG uptake unless associated with infection/inflammation | Seen as contrast jet extending outside valve annulus | TTE: 30–60%TEE: 90%PET: poor detectionCT: 80–95% | TTE: 90–95%TEE: 95–100%PET: poor detectionCT: 90–100% |
| Prosthetic valve dehiscence | Rocking motion of prosthesis, paravalvular regurgitation | Increased 18F-FDG uptake at the annular interface | Visualized as separation of prosthesis with abnormal angulation or movement | TTE: 30–50%TEE: 90–95%PET: 65–85%CT: ~85% | TTE: 90–95%TEE: 95%PET: 80–90%CT: 90% |
TTE: transthoracic echocardiography; TEE: transesophageal echocardiography; PET: positron emission tomography; CT: computed tomography; FDG: fluorodeoxyglucose; PVE: prosthetic valve endocarditis; LV: left ventricle; RA: right atrium.
TC: Investigation, Writing—original draft, Writing—review & editing. JER: Investigation, Writing—review & editing, Visualization. SLPV: Writing—review & editing, Validation. TKMW: Conceptualization, Supervision, Writing—review & editing, Project administration. All authors read and approved the final manuscript.
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