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Hypermetabolism of the spleen or bone marrow is an additional albeit indirect sign of infective endocarditis at FDG-PET

Journal of Nuclear Cardiology
MD Caroline Boursier, MD, PhD Xavier Duval, MD Besma Mahida, MD, PhD Bruno Hoen, MD François Goehringer, MD Christine Selton-Suty, MD Elodie Chevalier, MSc Véronique Roch, MSc Zohra Lamiral, MD Aurélie Bourdon, MD Nicolas Piriou, MD Amandine Pallardy, MD Olivier Morel, MD, PhD François Rouzet, MD, PhD Pierre-Yves Marie, the AEPEI-TEPvENDO Study Group
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The online version of this article (https://​doi.​org/​10.​1007/​s12350-020-02050-2) contains supplementary material, which is available to authorized users.
The members of the AEPEI-TEPvENDO Study Group was mentioned in Acknowledgements section.
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This study aimed at determining the diagnostic implications of indirect signs of infection at FDG-PET—i.e., hypermetabolisms of the spleen and/or bone marrow (HSBM)—when documented in patients with known or suspected infective endocarditis (IE).


HSBM were defined by higher mean standardized uptake values comparatively to that of the liver on FDG-PET images from patients with a high likelihood of IE and prospectively included in a multicenter study.


Among the 129 included patients, IE was ultimately deemed as definite in 88 cases. HSBM was a predictor of definite IE (P = 0.014; odds ratio (OR) 3.2), independently of the criterion of an abnormal cardiac FDG uptake (P = 0.0007; OR 9.68), and a definite IE was documented in 97% (29/30) of patients showing both HSBM and abnormal cardiac uptake, 78% (7/9) of patients with only abnormal cardiac uptake, 67% (42/63) of patients with only HSBM, and 37% (10/27) of patients with neither one.


In this cohort with a high likelihood of IE, HSBM is an additional albeit indirect sign of IE, independently of the criterion of an abnormal cardiac uptake, and could reinforce the suspicion of IE in the absence of any other infectious, inflammatory, or malignant disease.

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