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FDG-PET in Prosthetic Valve Endocarditis — EECC MCQ

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ModerateCardiac ImagingFDG-PET in Prosthetic Valve EndocarditisEECC

A 55-year-old man with prosthetic aortic valve endocarditis and negative TOE undergoes ¹⁸F-FDG PET/CT which shows intense focal FDG uptake around the prosthetic valve. What is the clinical significance?

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Correct answer: E — Periprosthetic FDG uptake is included as a major criterion in the 2023 ESC modified diagnostic criteria for prosthetic valve endocarditis, significantly improving diagnostic sensitivity

The 2023 ESC IE Guidelines have incorporated advanced imaging modalities into the modified diagnostic criteria. ¹⁸F-FDG PET/CT is now included as a major imaging criterion for prosthetic valve endocarditis (PVE), recognising its ability to detect periprosthetic infection (abscess, pseudoaneurysm) even when TOE is negative. PET/CT improves diagnostic sensitivity for PVE from ~70% (Duke criteria alone) to ~90% (with PET). Key caveats: (1) wait ≥3 months post-surgery to avoid false-positives from post-operative inflammation; (2) adequate patient preparation (prolonged fasting, heparin protocol) to suppress physiological myocardial FDG uptake; (3) PET also identifies distant embolic foci (splenic, cerebral, skeletal).

Reference: ESC (2023): Guidelines on Infective Endocarditis