The role of 18F-FDG PET/CT in infectious endocarditis: a systematic review and meta-analysis.

PURPOSE: To systematically review and conduct a meta-analysis of the available evidence for PET/CT using 18F-fluorodeoxyglucose as tracers in the imaging of infectious endocarditis (IE).

METHODS: Databases, including PubMed, Embase, and Web of Science, were searched for studies that examined the diagnostic value of 18F-FDG PET/CT for patients with IE. The reference lists following review articles and those of the included articles were checked to complement the electronic searches. The data extraction and methodological quality assessment were completed by two independent reviewers, and the meta-analysis was then conducted using Meta-Disc software, version 1.4.

RESULTS: A total of 6 studies involving 246 patients was included. The results of the meta-analysis indicated that the pooled sensitivity was 61% (95% confidence interval (CI), 52-88%), and the pooled specificity was 88% (95% CI, 80-93%). The positive likelihood ratio was 3.24 (95% CI, 1.67-6.28, p = 0.224), and the negative likelihood ratio was 0.50 (95% CI, 0.32-0.77, p = 0.015). The diagnostic odds ratio was 6.98 (95% CI, 2.55-19.10, p = 0.145), the overall area under the curve (AUC) was 0.8230 (SE = 0.1085), and the Q* value was 0.7563 (SE = 0.0979).

CONCLUSIONS: 18F-FDG PET/CT is currently not sufficient for the diagnosis of IE because of its low sensitivity. However, 18F-FDG PET/CT might be a useful tool for the diagnosis of skin and pocket cardiovascular implantable electronic device (CIED) infections and prosthetic valve endocarditis (PVE).