Figure 2
PET/CT and computed tomography angiography (CTA) findings. To assess for presence of extracardiac septic foci, a
18F-FDG PET/CT, performed after 3 days of dietary preparation and heparin pre-administration to suppress physiological myocardial FDG uptake was performed.
Left, Maximum intensity projection image of the thorax showing pathological accumulation of
18F-FDG in the heart area.
Right,
A,
B Transaxial view of
18F-FDG PET/CT (
A) and
18F-FDG PET/CTA (
B) showing focal FDG uptake of the chordea tendinae at the insertion in the anterolateral papillary muscle.
C,
D Transaxial view of
18F-FDG PET/CT (
C) and
18F-FDG PET/CTA (
D) showing focal FDG uptake of the chordea tendinae between the valve leaflet and the posteromedial papillary muscle. Due to the poor sensitivity, a negative
18F-FDG PET/CT cannot rule-out NVE. Based on its excellent specificity, positive valvular- or peri-valvular FDG uptake could be used to rule-in NVE, since no physiological FDG-uptake is expected in this area.
1 When using
18F-FDG PET/CT as major criterion for the NVE diagnosis, with state-of-the art dietary patient preparation, contemporary PET/CT devices (better spatial resolution) as well as delayed cardiac acquisitions (better contrast resolution), the sensitivity of
18F-FDG PET/CT in the NVE diagnosis is increased up to 80%, without altering the excellent specificity.
2 In NVE, valve leaflets and peri-annular area are the most commonly sites of cardiac FDG-uptake. Isolated involvement of the submitral apparatus in absence of myocardial FDG uptake are very rare, evoking inflammatory cardiomyopathy (sarcoidosis), intraventricular thrombus, neoplasm or infective endocarditis
3