The Role of Nuclear Cardiac Imaging in Infective Endocarditis

Purpose of Review

Infective endocarditis (IE) remains a deadly disease despite improvements in its management. Echocardiography is crucial for the diagnosis of IE; however, its value is operator-dependent and its sensitivity can decrease in the presence of valvular prosthesis. This review aims to provide an overview on the role of nuclear cardiac imaging in the diagnosis of IE.

Recent Findings

Among all nuclear cardiac imaging modalities, both radiolabeled leukocyte scintigraphy and 2-deoxy-2-fluorine-18]fluoro-D-glucose positron emission tomography/computed tomography (¹⁸F]FDG-PET/CT) have been recently introduced in the guidelines of European Society of Cardiology (ESC) for the management of IE. The ESC guidelines included some minor criteria (mainly clinical), and two different sets of major criteria based on blood culture and imaging, respectively. The positivity of either radiolabeled leukocyte scintigraphy or ¹⁸F]FDG-PET/CT images is considered itself a major criterion to diagnose IE. However, nuclear cardiac imaging analysis may be tricky and methodological and technical aspects should be carefully considered.

Summary

Available evidence supports the role of nuclear cardiac imaging in the diagnosis and management of IE. However, all practitioners who act within the “Endocarditis Team” should present a very high level of expertise.