FDG-PET CT for the evaluation of native valve endocarditis
Notice bibliographique
Résumé
645 Objectives: Infective endocarditis (IE) is associated with significant morbidity and mortality. Clinical presentation is highly variable, making the diagnosis of IE challenging. IE is usually diagnosed using the modified Duke criteria, however limitations associated with blood cultures and echocardiography reduce the diagnostic accuracy of the modified Duke criteria with approximately one third of patients investigated for IE classified as possible IE. F-18 Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is an extremely useful technique for evaluation of prosthetic valve IE but there is very limited and conflicting data on its role in native valve IE (NVE). The purpose of this retrospective study is to assess the role of FDG-PET/CT and its inclusion in the modified Duke criteria for the evaluation of patients with suspected NVE. Methods: 3D time-of-flight FDG PET/CT images in patients following myocardial suppression preparation with suspected NVE were retrospectively reviewed independently by two experienced physicians blinded to all clinical information. Abnormal focal increased FDG uptake greater than surrounding blood pool activity in the cardiac valve plane were considered positive for IE by visual analysis. The gold standard consisted of surgical findings, when available, or the modified Duke criteria. Results: 54 subjects were included, 31 (57%) with a diagnosis of NVE. A final diagnosis of NVE was established in 21/31 (67.7%) subjects by surgical cultures and 10/31 (32.3%) using the modified Duke criteria. FDG-PET/CT correctly identified 21/31 (67.7%) subjects with no false positive studies, yielding a sensitivity and specificity of 68% (95%CI: 49-83%) and 100% (95%CI: 85-100%), respectively. Positive and negative predictive values were 100% (95%CI: 84-100%) and 70% (95%CI: 51-84%), respectively. Interobserver agreement was substantial with κ = 0.65 (95%CI 0.45-0.86). Of the 10 false negative studies, 6 had incomplete myocardial suppression and 4 had complete suppression. After excluding subjects (17 patients, 31.5%) with incomplete myocardial suppression, sensitivity and specificity were 80% (95%CI: 56-94%) and 100% (95%CI: 80-100%) with positive and negative predictive values of 100% (95%CI: 79-100%) and 81% (95%CI: 58-95%), respectively. The sensitivity and specificity of the modified Duke criteria were 48% and 74%. 18 subjects (33.3%) were classified as Possible IE with the modified Duke criteria; 13 (72.2%) of which had a final diagnosis of IE based on the gold standard. Positive and negative predictive values of PET were 100% (95%CI: 84-100%) and 70% (95%CI: 51-84%), respectively. Modifying the Duke criteria to include FDG-PET positivity as a major criterion increased sensitivity to 77% without affecting specificity and led to the correct reclassification of 8/18 (44.4%) subjects from Possible IE to Definite IE. Conclusions: The addition of a positive FDG-PET/CT as a major criterion in the modified Duke Criteria improved performance of the criteria for the diagnosis of NVE, particularly in those subjects with possible IE. Optimal myocardial suppression techniques and PET/CT devices are crucial in this patient population.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».