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PET-CT in PVE — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionPET-CT in PVESCE Infectious Diseases

A 60-year-old man with prosthetic aortic valve endocarditis has been on IV antibiotics for 4 weeks. His team wants to assess response. Which imaging modality is most useful for assessing treatment response and detecting complications in prosthetic valve endocarditis?

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Correct answer: D — FDG PET-CT — superior to echocardiography for detecting perivalvular infection, abscess, and graft infection in prosthetic valve endocarditis

FDG PET-CT has transformed the diagnosis and monitoring of prosthetic valve endocarditis. It detects metabolically active perivalvular infection, abscess, and mycotic aneurysm with higher sensitivity than echocardiography (which may be limited by prosthetic shadowing). PET-CT is now a major criterion in the 2023 ESC modified Duke criteria for PVE diagnosis. It is particularly valuable for: prosthetic valve/graft infection, cardiac device infection, and identifying metastatic infection sites. Serial PET-CT can monitor treatment response (decreasing FDG uptake indicates improving infection).

Reference: ESC 2023 – Endocarditis guidelines; NICE 2024 – Nuclear cardiology